An Electrocoagulation Fixation Technique for One-Piece Intraocular Lens Scleral Flapless Fixation With Sutures Without Knots

Abstract

Purpose: To present an electrocoagulation fixation technique for one-piece intraocular lens (IOL) scleral flapless fixation with sutures without knots.Methods: First of all, after repeated tests and comparisons, we chose 8-0 polypropylene suture as the material for electrocoagulation fixation of one-piece IOL haptics because of its proper elasticity and size. A transscleral tunnel puncture at the pars plana was performed using an arc-shaped needle with 8-0 polypropylene suture. The suture was subsequently guided out of the corneal incision by a 1-mL syringe needle and then guided by the needle into the inferior haptics of the IOL. The suture was cut off and heated into a shape of a probe with a spherical tip using a monopolar coagulation device to prevent slippage from the haptics.Results: In the end, 10 eyes underwent our new surgical procedures, and the average operation time was 42.5 6 12.4 minutes. At the 6-month follow-up, seven of 10 eyes achieved significant vision improvement and nine of 10 kept the implanted one-piece IOL stable in the ciliary sulcus. No serious intraoperative/postoperative complications were observed. Conclusion:The electrocoagulation fixation was a safe and effective alternative technique for previously implanted one-piece IOL scleral flapless fixation with sutures without knots.

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.…”

“…8 − 0 polypropylene suture is used instead of 10 − 0 suture to enhance the elasticity and reduce the erosion and degradation of suture in the long term. Secondly, electrocoagulation xation technique for one-piece IOL we proposed previously 10 is used to increase the stability of soft loop, prevent the most important problem of tilt or eccentricity in IOL implantation, 21 and prevent or reduce complications related to lens-iris friction. Thirdly, Z.S.…”

“…The needle was cut off and then the broken suture end was scalded into the shape of a ball with monopolar coagulation device to prevent slippage from the haptics according to the method we reported earlier. 10 The rst transscleral tunnel puncture (Fig. 1A, 1B) at 6 o'clock position (or other pre-designed clock positions) of the pars plana 1.5-2.0mm posterior to the limbus was performed with a 30G needle of 1 ml insulin syringe.…”

“…9 reported a kind of Z-suture knotless technique of 10 − 0 polypropylene suture, which perfectly solved the problem of knot exposure. However, 10 − 0 suture is too thin and easy to break or corrode, 10 so it is necessary to introduce a knotless scleral xation technique with thicker suture. So, we introduce a new compound technique (which we called "Z.S.…”

Current Evidence for a New Surgical Technique for Scleral Fixation: The Implantation of a Carlevale Lens, a Systematic Review

“…Through our analysis of the intra- and post-operative complications we can affirm the good safety profile of this suture-less IOL, with a low rate of endophthalmitis, damage to corneal endothelial cells and IOL dislocation [ 8 , 35 , 48 ]. The few cases of scleral erosion that have been observed were not related to the lens but to a thinner sclera, such as in myopic eyes [ 49 ], and this complication was solved by rotating the lens and creating new scleral flaps [ 49 ].…”