Modified technique for transscleral fixation of posterior chamber intraocular lenses

Abstract

BackgroundSuture exposure remains to be a potential problem of transscleral fixated posterior chamber intraocular lens (PCIOL). We report a modified technique to minimize the risk of suture exposure for the transscleral fixation of PCIOL.MethodsThe modified surgical technique is as following: at first, two 3 mm × 4 mm square scleral pockets were created from groove incisions at opposite positions. A straight needle attached to a 10–0 polypropylene suture was passed through one incision groove. Then, a 27-Gauge hollow needle passed through the opposite sclera incision bed was used to retrieve the straight fine needle via its barrel. The sutures were tied to themselves after one more bite on the scleral bed. At last, the suture ends were left long (about 4 mm) and laid flat into corresponding laminar scleral pockets. This modified technique of PCIOL was performed in 48 post-traumatic aphakic vitrectomized eyes from 48 patients (47 male, one female) with mean age of 34.8 ± 14.8 years. Main outcome measures included best corrective visual acuity (BCVA), IOL decentration, IOL tilt, and postoperative complications.ResultsThe mean follow-up was 32.3 ± 10.8 months (3–67 months). The LogMAR BCVA remained stable, from a preoperative value of 0.46 ± 0.34 to postoperative 0.44 ± 0.34 (p = 0.69). Mild IOL tilt (5–10°) was observed in five eyes, and slight IOL decentration (0.5–1.0 mm) was seen in three cases. No case of suture exposure, suture breakage, IOL dislocation, or endophthalmitis was observed during the follow up period.ConclusionThe modified technique allowed stable placement of PCIOLs in post-traumatic aphakic eyes with a wide range of follow-up. Our procedure might have the potential benefit to avoid suture exposure in scleral-fixated IOL implantation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12886-015-0118-8) contains supplementary material, which is available to authorized users.

Outcomes of Sutureless Iris-Claw Lens Implantation

“…The same frequency occurs in the case of anterior chamber iris-claw IOL [11]. It is comparable with the cases of AC-IOL and SF-IOL, where the rate of edema is observed in 2.7% to 10.4% [1, 17]. However, the limitation of this study is its retrospective character and the lack of the regular OCT screening.…”

Retropupillary iris claw intraocular lens implantation in aphakia for dislocated intraocular lens

“…The best method is one that offers best visual outcome with lowest complication in an already delicate situation. Each of the available options has its own risks and complications: transscleral fixation of posterior chamber IOLs has the advantage of posterior position of IOL, but it is a time-consuming procedure with known complications 9,10…”

Visual Outcome in Scleral Fixated Intraocular Lenses

“…Scleral fixated IOL should be the preferred method of secondary IOL implantation as it most physiological in position as compared to AC-IOL or iris claw lens. (9,10,11) Both lenses have disadvantage of corneal touch and loss of endothelium in long run and also secondary uveitis and glaucoma. (12) Moreover, such complicated cataract surgery patients are prone to develop some retinal or posterior segment pathology in future and then it becomes easier to examine the posterior segment in scleral fixated IOL where pupil can be medically dilated while this is not possible with AC-IOL or iris claw lens.…”