A modified intrascleral intraocular lens fixation technique with fewer anterior segment manipulations: 27-gauge needle-guided procedure with built-in 8–0 absorbable sutures

Abstract

BackgroundTo report a modified surgical technique for intrascleral intraocular lens (IOL) fixation with fewer anterior segment manipulations in eyes lacking sufficient capsular support.MethodsEyes from 14 patients who underwent 27-gauge needle-guided intrascleral IOL fixation with built-in 8–0 absorbable sutures were studied. The 8–0 absorbable sutures were inserted into 27-gauge round needles and used to create sclerotomies at the 4 o’clock and 10 o’clock positions under the scleral flap. The sutures were used to tie knots at the end of each haptic and guide haptic externalization through the sclerotomy. After externalization, a sufficient flange was created at the end of each haptic and fixed under the scleral flaps. The best corrected visual acuity (BCVA), corneal endothelial cell density (ECD), IOL tilt and decentration, previous surgery history, and complications were determined.ResultsFourteen cases were analyzed. The majority of eyes exhibited an improvement in the BCVA after surgery. When comparing the last follow-up to preoperative visual acuity, the mean change in BCVA was + 26.32 letters (p = 0.011). Postoperative complications included postoperative hypotony in 3 eyes, ocular hypertension in 2 eyes. No cases of postoperative cystoid macular edema (CME), vitreous hemorrhage (VH), IOL dislocation, or endophthalmitis were observed.ConclusionsThe 27-gauge needle-guided intrascleral IOL fixation technique with built-in 8–0 absorbable sutures is easy to perform with fewer anterior chamber manipulations and achieves both anatomical and optical stability.

Long-Term Stability of Intraocular Lens with Trimmed or Untrimmed Haptics in Yamane Sutureless Intrascleral Fixation Technique

“…The first time before the IOL insertion into the anterior was to reduce the difficulty in introducing the haptics caused by the overlong haptics in the eye, especially in the introduction of the trailing haptic. This problem has also been pointed out by some surgeons [ 11 , 17 ]. In our experience, the trimmed haptic is easier threaded into the needle.…”

“…Second, externalization of the haptics can be completed using intraocular forceps [ 5 ], sutures [ 11 ], and needles [ 7 , 13 ]. Although using forceps is simple and convenient, it can cause haptic deformation or fracture when the direction of traction is different from the haptic.…”

“…Lastly, there are many ways to fix haptics, such as scleral flaps with sutures or fibrin glue [ 6 , 11 ], Y-fixation [ 8 ], hook-shaped haptics [ 12 ], and flanged haptics [ 13 ]. Kumar et al reported that the degree of scleral erosion by the haptic was associated with the depth of scleral tunnels, and a subconjunctival haptic extrusion was seen in 3 eyes (1.4%) with thin scleral flaps [ 14 , 15 ].…”

“…The corneal endothelial cell density (ECD) was detected by confocal microscopy (Confoscan 3.0, NIDEK, Japan) before surgery and at 1, 6, 12, and 24 months after surgery. The IOL position, including IOL tilt, decentration, and haptics location, was detected by Visante anterior segment optical coherence tomography (AS-OCT) (Carl Zeiss Meditec, Jena, Germany) at 1, 3, 12, and 24 months after surgery [ 11 , 13 ]. The reference line was set between the iris-corneal angles.…”

Sutureless Scleral Fixated IOL: The “Catcher Pole” Technique

“…More recent techniques have been reported to overcome these difficulties. [3][4][5][6][7]24,25 The major advantage of the "Catcher Pole" technique depends on the adaptation of a disposable 23 or 25 G cannula with a retractile wired loop normally used as retinal scraper, inserted into the temporal and nasal scleral tunnel to externalize the haptic tip with minimal or no damage. Due to the adaptation of an instrument designed for different purposes, the complete retraction of the loop and the metallic structure of the wire may damage the haptic and even cut it if excessive strength is applied on the push button in retraction.…”