Flanged intraocular lens fixation via 27‐gauge trocars using a double‐needle technique decreases surgical wounds without losing its therapeutic effect

Abstract

Purpose: Intraocular lens (IOL) fixation using a sutureless 27-gauge needle intrascleral IOL implantation technique requires six surgical wounds. We developed a modified technique using two 27-gauge trocars for vitrectomy and indwelling flanged IOL haptics to reduce the number of surgical wounds. Setting: Methods: Patients who underwent IOL scleral fixation and were observed for >12 weeks were analysed using medical record data. Before October 2017, patients underwent normal flanged IOL scleral fixation. Between November 2017 and April 2019, patients underwent the modified method (flanged IOL via 27-gauge trocars with double-needle technique). Primary end-point was superiority or non-inferiority of modified IOL scleral fixation compared with normal IOL scleral fixation for visual acuity (VA). Changes in corneal endothelium cell number, refractivity, astigmatisms and surgery-related complications, were secondary end-points. Results: There were no significant differences in baseline characteristics between groups. Raw VA and best collected VA (BCVA) were significantly improved in all eyes (pÀ). There were no statistical significances in raw VA, BCVA and surgery-related complications between groups. Conclusions: Results of the modified technique were not inferior compared with the original technique although it was less invasive. Therefore, flanged IOL fixation via trocars using a double-needle technique is a useful technique for IOL implantation.Key words: intraocular lens implantation -intraocular lens scleral fixation -micro incision vitrectomy surgery -pars plana vitrectomy -surgery technique Acta Ophthalmol. 2020: 98: e499-e503

A Modified Intrascleral Intraocular Lens Fixation Technique Using 27-Gauge Blunted Needles with Fewer Intraocular Manipulations

“…Surgical outcomes were comparable to those of previously described techniques of intrascleral fixation of IOL [ 22 , 23 , 26 ] ( Table 2 ). Our study did not have a control group, but the IOL position looked acceptable even when our technique was performed using anatomical markers.…”

“…Owing to these factors, we often observe IOL dislocation or exposure of the flanged haptic, and it is sometimes difficult to reposition the IOL. Therefore, many surgeons have been trying to modify the technique for the better [ 23 , 24 , 26 ]. We considered methods to develop a fool proof technique for intrascleral fixation of IOL with fewer intraocular manipulations.…”

“…Implantation of an intraocular lens (IOL) in the absence of capsular support has been accomplished by using an anterior chamber (AC) IOL [ 1 – 4 ], iris-fixed IOL [ 5 – 7 ], and intrascleral fixed posterior chamber (PC) IOL [ 8 – 26 ]. In recent years, sutureless techniques for intrascleral fixation of IOL are gaining popularity among ophthalmic surgeons because of lesser incidence of corneal endothelial cell loss, glaucoma, and peripheral anterior synechiae [ 1 – 4 ], despite the invention of new techniques of retropupillary iris-fixed IOL fixation over the past few years [ 5 – 7 ].…”

Clinical outcomes of combined pars plana vitrectomy and scleral fixation of the intraocular lens with a suspension bridge method in eyes with aphakia or insufficient capsular support

“… 2020 ; Ishikawa et al. 2020 ). However, many of these techniques require intricate surgical manoeuvres and are associated with an increased risk of surgical trauma.…”

A Modified Flanged Intrascleral Intraocular Lens Fixation Technique Using an Externalized Needle for Haptic Docking

“…2 Several modifications on his original technique have been published, including a modification that we have adopted whereby the leading haptic is docked into a needle without the use of intraocular forceps. [3][4][5][6][7][8][9][10][11] We describe a technique that is ideal for the anterior segment surgeon that may have less comfort docking haptics in the posterior segment. Additionally, this method avoids challenges associated with limited visualization of the posterior segment and could potentially obviate the need for intraocular lens forceps.…”