A novel surgical approach for fixation of a posterior chamber intraocular lens of Rayner 620 H with Gore-Tex suture

Abstract

Purpose To report a novel surgical approach for the scleral fixation of the Rayner 620 H intraocular lens (IOL) with Gore-Tex suture and its outcomes at 6 months postoperatively. Methods 19 consecutive patients who underwent novel surgical approach for the scleral fixation of Rayner 620 H IOL with Gore-Tex suture at Peking Union Medical College Hospital between June 2020 and June 2021 were included. Data on best-corrected visual acuity (BCVA), spherical equivalent, total astigmatism/axis, short-term and long-term complications, and corresponding management with a follow-up of 6 months were collected. Results Nineteen patients (11 men and 8 women) with a mean age of 62.7 ± 10.6 years were included. The median BCVA improved significantly from 0.90 ± 0.90 (Snellen 20/160) preoperatively to 0.20 ± 0.30 (Snellen 20/32) at postoperative 6 months follow-up (P < 0.001). The stratification of the accuracy of refractive outcomes was 53% of patients within ± 0.5 D and 84% of patients within ± 1.0 D of the refractive target. Corneal edema (n = 3, 16%) and increased intraocular pressure (IOP) (n = 4, 11%) were short-term complications. Long-term complications included increased IOP (n = 1, 5%), and macular edema (n = 1, 5%). Conclusion The novel surgical approach for scleral fixation of the Rayner 620 H IOL with Gore-Tex suture is a reasonable option for patients who need secondary IOL placement without adequate capsular support.

Research on the Z.S. technique for 8-0 polypropylene suture in scleral fixation of one-piece intraocular lens

“…Finally, this technique was also applicable to the scleral xation of astigmatic IOL due to another electrocoagulation xation technique of IOL loop we proposed previously. 10 The most common cause of IOL scleral xation in our observation was aphakia (11 eyes, 68.75%), which was similar to Zhang Y et al's report (18 eyes, 100%), 1 but different from Wang T et al's report, 7 which believed that the most common cause was subluxated/dislocated lens. The traditional view was that the three-piece polymethyl methacrylate IOL was more suitable for scleral xation due to the greater elasticity of the loop, but the three-piece IOL needed to be knotted and xed with suture, [17][18][19][20] which had the risk of tilt or eccentricity of IOLs due to the suture knot shift in the long term.…”

“…In our study, it was found that among all the population who received secondary IOL implantation, men accounted for a higher proportion, with an average age of about 60 years, similar to previous literature reports. 7,8 As for the selection of suture, 10 − 0 suture was often used for scleral xation of IOL in the early stage. 4,5 However, as time went on, the complications related to too thin/degradable 10 − 0 polypropylene suture such as suture erosion and fracture became more and more prominent.…”

“…16 In order to reduce the adverse outcomes related to the suture knot, ophthalmologists had to make additional scleral ap, scleral groove or tunnel to wrap the too thick suture knot, which increased the operation time and new trauma. 7 So, Z.S. scleral xation technique came into being.…”

“…Complications occurring within 1 month after surgery were de ned as short-term complications, whereas long-term complications were de ned as complications that occurred more than 1 month after the procedure. 7 Transient ocular hypertension was de ned as an IOP of more than 21 mmHg. 8 This study was approved by the Institutional Review Board of Fuzhou Eye Hospital and conducted in accordance with the tenets of the Declaration of Helsinki (approval No.…”

“…1 However, scleral xation of IOL can be divided into sutureless scleral xation 2,3 and sutured scleral xation. [4][5][6][7][8][9] At present, most scleral xation methods [4][5][6][7][8] required knot xation outside the sclera, no matter 10 − 0 or 8 − 0 polypropylene suture. As the complications related to 10 − 0 suture erosion, knot exposure and late suture breakage 7 have gradually attracted the attention of ophthalmologists, it is particularly important to introduce the technique and concept of knotless suture.…”