Novel technique of sutureless glueless scleral fixated intraocular lens (SFIOL)

Abstract

Purpose:To report results of a novel technique for sutureless, glueless intrascleral fixation of three-piece posterior chamber intraocular lens (IOL) using 26-G needle for management of aphakia.Methods:In this prospective series, 30 eyes of 20 patients with aphakia, subluxated IOL, or crystalline lens were included. 26-G-needle-guided intrascleral fixation of three-piece posterior chamber IOL was performed according to the described technique. The patients were evaluated on day 2, 1 week, 6 weeks, and 3 months postoperatively for change in best-corrected visual acuity (BCVA), intraocular pressure (IOP), IOL centration, and any other complications. The postoperative tilt of the IOL was indirectly measured by determining the lenticular astigmatism which in turn was calculated by the difference between net corneal astigmatism and refractive astigmatism. Paired t-test was used to determine the significance of any association between the preoperative and postoperative BCVA and IOP. P < 0.05 was considered significant.Results:Of 30 eyes (n = 30 patients), 18 were surgical aphakia, 6 traumatic aphakia, 5 subluxated IOL, and 1 ectopia lentis (Marfan syndrome). The mean preoperative BCVA was 1.37 ± 0.37 (logMAR) and postoperative BCVA at 3 months was 0.37 ± 0.29 (logMAR). A significant improvement in the mean BCVA (P < 0.05) was observed after the procedure. The mean IOP preoperatively was 13.33 ± 4.18 and postoperatively at 3 months was 12.82 ± 3.97 (P > 0.05), which was not significant. None of the eyes developed any intraoperative and postoperative complications. The IOLs had appropriate centration and stability.Conclusion:We have developed this new technique for intrascleral IOL fixation which is quite simple, cost-effective, minimally invasive, neither requires glue nor suture and gives consistent outcome.

Scleral tunnel with conjunctival autograft for rescue management of extruded haptic

“…A 1.1 mm wide and 2 mm long scleral tunnel fashioned with a 20 guage MVR in our technique covers a 0.14 mm wide haptic adequately and prevents torsional instability of the IOL by promoting proportionate haptic tuck on either side respectively. [ 15 ] We believe that unnatural tension develops if curved haptics of a 3-piece lens (MA60MA) inadvertently configure a vertical position, and this results in cheese-wiring of the overlying scleral flaps [ Fig. 3a ].…”

“…By filling the gap around the haptic and by sealing previous sclerotomy site, FG may allow good intrascleral apposition and prevent its further slippage. [ 15 ]…”

Complications and visual outcome of sutureless, scleral fixated intraocular lens in cases with traumatic aphakia

“…However, the steps of scleral tunnel construction and haptic tucking were slightly modified as compared with the original X-NIT and other similar techniques. 10 , 11 , 15 Conjunctival peritomy was done from 3 to 9 o’clock superiorly followed by cauterization of the bleeders to achieve haemostasis. Two points were marked at limbus 180° apart with a marker pen, preferably at 3 and 9 o’clock positions ( Figure 1(a) ).…”

“… 3 , 8 Sutureless SFIOL techniques were, thus, adopted to reduce suture-related complications. These techniques involve exteriorization of the haptics and embedding them in scleral tunnels, 9 – 11 fixing the haptic with glue below scleral flaps 12 or flanging the haptic tips with cautery. 13 Data on the outcomes of IOL implantation in cases of traumatic aphakia are limited in the existing literature.…”

“…Various techniques have been described for exteriorization of the haptics 10 – 16 and to secure the haptics into the scleral pockets. 9 , 10 , 14 – 17 However, all the techniques described for haptic management have risk of accidental rebound of the haptics into vitreous cavity and intraoperative IOL drop, especially for the beginners.…”