Novel use of an adjustable single 8–0 polypropylene suture of scleral fixation without conjunctival dissection

Abstract

Background: This report serves to describe the use of a novel adjustable single 8-0 polypropylene suture for scleral fixation without conjunctival dissection, and to describe related clinical outcomes associated with this approach. Methods: In this study, we retrospectively reviewed 28 eyes from 27 patients that underwent scleral fixation of the intraocular lens (IOL) without conjunctival dissection using an adjustable single 8-0 polypropylene suture at the Beijing Tongren Eye Center between April 2018 and April 2019. For this surgical approach, a 23-gauge infusion cannula was set, after which two Hoffmann scleral pockets were created. Next, 8-0 polypropylene sutures were inserted into the eye guided by 10-0 polypropylene sutures of a long straight needle. The 8-0 suture was then used to fix the haptic IOs. Finally, these 8-0 polypropylene sutures were removed from the scleral pockets, and knots were tightened with the adjustable single suture. Primary outcomes included visual acuity and postoperative complication incidence. Results: For this study, outcomes for 28 eyes from 27 patients (9 female, 18 male) were assessed. Patients had a mean age of 54 ± 15.11 years-old and were followed for an average of 10.18 ± 2.76 months postoperatively. Uncorrected visual acuity in these patients improved significantly from a preoperative value of 1.269 ± 0.464 logMAR to a 3-month postoperative value of 0.409 ± 0.413 logMAR (p = 0.000). The majority of postoperative complications in these patients were temporary and self-limiting, including corneal edema (35.71%), hypotony (14.29%), elevated intraocular pressure (28.58%), and mild hyphema (7.14%). No evidence of exposure or erosion of the trimmed suture end was detected in any patients. An ultrasound biomicroscope was able to readily detect the IOL and all sutures, and IOLs were found to be well-centered without any dislocation, tilting, or subluxation upon follow-up. Conclusions: An adjustable single 8-0 polypropylene suture can reliably and effectively be used for scleral fixation without conjunctival dissection for the treatment of patients with aphakia or inadequate posterior capsule support. The novel procedure described herein may therefore be an effective means of minimizing the risk of suture-related complications in patients undergoing scleral-fixated IOL implantation. Trial registration: Retrospective case series study, not applicable. NCT04476264.

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

“…From the perspective of long-term effects, also because the 10-0 polypropylene suture is too thin, the suture will loosen or even erode at the fixed end of the sclera, which may easily lead to subluxation of the IOL. 5,6 2. The 8-0 polypropylene suture has strong tensile strength.…”

Modified Technique for Scleral-Sutured Fixation with the Double Knots Technique for Posterior Chamber Intraocular Lens: Short-Term Observation

“…In our study, by means of a relay, the 23 needles first entered the anterior chamber at the marked position, thus leading to the stitches, which helped simplify the identification of sclerotomy sites and provided control over the insertion angles. This method may effectively reduce the incidence of IOL tilt and eccentricity after surgery and decrease the number and time of surgical instruments entering the eye, thereby reducing the occurrence of a series of complications such as endophthalmitis and intraocular hemorrhage [ 15 , 27 ]. Postoperative best-corrected visual acuity was improved in most of patients of current study ( p < 0.01), and no serious complications occurred except for a few cases of transient intraocular pressure increase during the follow-up period.…”

“…Data from patients with a < 3-month postoperative follow-up or with incomplete operative or postoperative medical records were excluded from this study. Enrolled patients had complete records pertaining to their visual acuity (VA), slit-lamp photographs, and ultrasound biomicroscope (UBM) findings [ 15 ]. During their initial baseline visit, each patient was subjected to comprehensive ophthalmic evaluations of best-corrected visual acuity (BCVA), as well as intraocular pressure, lens status, previous surgeries, preexisting ocular pathologies, and history of ocular trauma [ 15 ].…”

“…Enrolled patients had complete records pertaining to their visual acuity (VA), slit-lamp photographs, and ultrasound biomicroscope (UBM) findings [ 15 ]. During their initial baseline visit, each patient was subjected to comprehensive ophthalmic evaluations of best-corrected visual acuity (BCVA), as well as intraocular pressure, lens status, previous surgeries, preexisting ocular pathologies, and history of ocular trauma [ 15 ]. The list of analyzed postoperative outcome measures comprised BCVA, corneal endothelial cell density, and complications.…”

Biomechanical testing of a modified knotless transscleral suture fixation technique: an ex vivo study

“…However, the IOL dislocation rate has increased over time, suggesting that suture rupture caused by degeneration of sutures is a factor that cannot be ignored ( 12 , 13 ). Recently, the 8-0 polypropylene suture has been used in traditional transscleral suture fixations due to its high tensile strength and comparatively lower susceptibility to degradation, but few studies have evaluated the biomechanical performance of 8-0 polypropylene suture in patients with IOL transscleral suture fixation ( 14 , 15 ). Additionally, knot-related problems, such as knot exposure, knot erosion, and suture erosion, are difficult problems caused by traditional transscleral suture fixations ( 8 , 16 , 17 ).…”