Scleral Fixation of a Toric Lens to Treat Corneal Astigmatism in Eyes without Capsular Support

Abstract

Purpose To describe surgical technique and report short-term visual outcomes after suture-fixation of a single-piece eyelet-toric (SET) intraocular lens (IOL) for treatment of concurrent aphakia and astigmatism. Design Retrospective, noncomparative, and non-consecutive case series. Methods This was a case series of eleven eyes who underwent successful SET. Eligible eyes had loss of capsular support or aphakia with a minimum of symmetric corneal astigmatism 1.75 diopters (D). Outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), magnitude of residual refractive cylinder, and complications resulting from the SET procedure. Results Preoperative UDVA and CDVA in logMAR scale were 1.46 and 0.45, respectively. Mean preoperative keratometric and refractive cylinder were 3.67 D and 2.52D, respectively. Postoperative UDVA and CDVA were 0.51 and 0.27, respectively, three months after surgery (POM3). Residual refractive cylinder at POM3 was 0.93 D. Conclusion SET technique reduced refractive cylinder and improved UDVA and CDVA. SET may be adapted by surgeons using a readily available IOL and familiar scleral-fixation maneuvers.

Scleral Fixation of Toric Intraocular Lens in the Absence of Capsular Support

“…The authors used two-point suture scleral fixation of MX60T TIOL. Prior to insertion, the haptics were trimmed distal to the eyelet [ 3 ].…”

“…The steep axis of the toric MX60T IOL is linear with the eyelets, which is crucial to align the lens with the axis of astigmatism [ 3 ]. Due to its design, the lens is suitable for “pseudo-4-point fixation” with scleral sutures [ 4 ].…”

Secondary single-piece toric posterior chamber intraocular lens fixation

“…[6][7][8][9][10][11][12][13] Some techniques have specifically been described to secondarily fixate toric single-piece PC IOLs. 14,15 Without standardization of the haptic location relative to the toric axis of IOL, the degree of offset required for scleral haptic fixation relative to the toric axis is not universally applicable across IOL manufacturers. In addition, described techniques often require complex intraocular suturing and knot-tying maneuvers.…”