In-the-bag scleral suturing of intraocular lens in eyes with severe zonular dehiscence

Abstract

PurposeTo compare the degree of tilt and decentration of an intraocular lens (IOL), refractive status, and prediction error between eyes that underwent trans-scleral suturing of the IOL within the capsular bag (in-the-bag scleral suturing) and eyes that underwent scleral suturing outside of the bag (out-of-the-bag scleral suturing) because of severe zonular dehiscence.Patients and methodsThirty eyes that underwent in-the-bag scleral suturing of an IOL and 38 eyes that underwent out-of-the-bag scleral suturing were recruited sequentially. The tilt and decentration of the IOL, anterior chamber depth, manifest refractive spherical equivalent (MRSE), prediction error, and incidence of complications were examined.ResultsThe mean tilt angle and the decentration length of the IOL of the in-the-bag suturing group were significantly less than those of the out-of-the-bag suturing group (P=0.0003 in tilt and P=0.0391 in decentration), although the anterior chamber depth was similar. The mean MRSE and prediction error of the in-the-bag suturing group were less than those of the out-of-the-bag suturing group (P=0.0006 in MRSE and P=0.0034 in error). The incidence of vitreous loss was less in the in-the-bag suturing group than in the out-of-the-bag suturing group (20% vs63.2%, P=0.0009).ConclusionsThe tilt and decentration of the IOL after in-the-bag scleral suturing are significantly less than those after out-of-the-bag scleral suturing, which may lead to less MRSE and less prediction error. As the incidence of vitreous loss is less after in-the-bag scleral suturing, in-the-bag suturing is advantageous for eyes of younger patients and of less complicated cases.

Evaluation of Intraocular Lens Tilt and Decentration in Congenital Ectopia Lentis by the Pentacam Scheimpflug System

“…Hayashi K's study showed that the tilt and decentration of the IOL after out-of-the-bag implantation were significantly greater than those after in-the-bag implantation, and the extent of both tilt and decentration after scleral suture fixation was greater than that observed after either out-ofthe-bag or in-the-bag implantation [19,20], which was consistent with part of our findings. In comparison with data in the published literature, our study showed that the tilt of the IOL after trans-scleral fixation in CEL patients was not significantly greater than that after in-the-bag implantation in cataract patients, whereas the decentration of the IOL in CEL patients was significantly greater [21].…”

Efficacy of haptic sutured in-the-bag intraocular lens for intraocular lens-capsule complex stability: a comparison of three insertion methods

“…Retaining the haptics in the bag can stretch the capsular bag (especially toward the direction of zonulysis) according to the total length of the planned IOL. In traditional sulcus scleral fixation methods, total capsular phimosis or bag shrinkage or bag distortion can be caused by an absence of the IOL haptics in the bag [29][30][31] . This technique can also prevent total capsular phimosis or bag shrinkage due to an absence of the IOL haptics as seen in traditional scleral sulcus fixation.…”

Intraocular lens intracapsular fixation with unilateral loop suture for 180 degree Zinn’s zonule dialysis

“…Moreover, it is necessary to observe the patient postoperatively for unstable fixation, such as IOL inclination. 15 , 16 …”