A Modified Knotless Transscleral Intraocular Lens Fixation Technology for Congenital Ectopia Lentis

Abstract

Introduction This study aimed to compare modified knotless transscleral suture fixation of intraocular lens (IOL) with traditional transscleral suture fixation for adolescents and young patients with congenital ectopia lentis (CEL). Methods This retrospective cohort study included 49 patients with CEL (60 eyes) who underwent surgery at the Zhongshan Ophthalmic Center. Improvements based on knotless Z-suture fixation technique were made to form a modified knotless method, in which thicker 8–0 polypropylene sutures were used, and double parallel scleral grooves were constructed behind the limbus instead of triangular lamellar scleral flaps to cover suture stitches. Modified knotless transscleral fixation of IOL was conducted on 30 eyes, and the other 30 eyes underwent traditional transscleral fixation surgery. Pre- and postoperative best-corrected visual acuity (BCVA), refractive error, astigmatism, other ocular parameters, and complications were statistically analyzed. Results For patients in the modified knotless group, the mean cylindrical refractive error and astigmatism at 1 month and 3 months postoperative were lower (all P < 0.05), and the mean IOL tilt degree was smaller at 3 months postoperative (3.21° ± 2.13° vs. 5.65° ± 3.66°, P = 0.032). The incidence of suture exposure in the modified knotless group was also lower than in the controls (0 vs. 16.7%, P = 0.026). No group differences were observed in mean BCVA, spherical equivalent, or other ocular biometric parameters between groups. Conclusion Modified knotless technique was a valid method to achieve optimal IOL position and reduce postoperative astigmatism for adolescents and young patients with CEL. It effectively reduced the incidence of knot-related complications, greatly improved the postoperative comfort, and achieved aesthetic benefits. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-022-00586-9.

Zonule-Associated Gene Variants in Isolated Ectopia Lentis and Glaucoma

“…Patients with EL typically present with decreased visual acuity, refractive error, and diplopia. 10,11 In addition, EL is an insidious disease in clinical settings, in which some coalescent manifests with EL. The presence of coexisting amblyopia, glaucoma, or retinal detachment can easily lead to misdiagnosis or missed diagnosis by physicians.…”

“…Mild cases of EL are easily missed by physicians, especially when EL does not occur in combination with trauma or systemic diseases. Patients with EL typically present with decreased visual acuity, refractive error, and diplopia 10,11 . In addition, EL is an insidious disease in clinical settings, in which some coalescent manifests with EL.…”

Postoperative longitudinal refractive changes in children younger than 8 years with ectopia lentis and Marfan syndrome

“…18,19 The surgical technique has been reported in detail in our previous study. 20 In summary, scleral grooves were made at 4 o'clock and 10 o'clock, and main corneal incision was made at 12 o'clock. The crystalline lens was removed with the assistance of capsular retractors.…”

Outcomes of three-piece rigid scleral fixated intraocular lens implantation in subjects with deficient posterior capsule following complications in manual small incision cataract surgery

“…Sutured and sutureless SFIOLs were used in SFIOL insertion procedures. Suture breakage, exposure to suture knots, with other postoperative complications may be related to suture SFIOL [ 30 ].To minimize such knot-related complications, further many other techniques carried out recently for better surgical outcomes [ [31] , [32] , [33] , [34] ]. As vitreoretinal and cataract operating innovations and improved technologies arise, more medical evidence is crucial to analyze the updated surgical success of SFIOL in vitrectomized eyes.…”