Scleral fixation without conjunctival dissection

Abstract

Scleral fixation of intraocular lenses (IOLs) and adjunctive capsular devices can be performed under the protection of a scleral flap. A modification of this technique uses a scleral pocket initiated through a peripheral clear corneal incision. Full-thickness passage of a double-armed suture through the scleral pocket and conjunctiva, with subsequent retrieval of the suture ends through the external incision for tying, facilitates scleral fixation. This modification offers several advantages over traditional methods: It eliminates the need for conjunctival dissection and scleral cauterization; a scleral pocket affords a greater surface area for suture placement through an ab externo or ab interno approach; retrieval of the sutures through the external corneal incision and subsequent tying allows the suture knot to pass under the protective roof of the scleral pocket, negating the need for suture knot rotation; and the architecture of the scleral pocket eliminates the need for sutured wound closure. Suture retrieval and scleral fixation through a corneoscleral pocket offers a refined method for fixation of IOLs and other intraocular adjunctive devices.

Half-bow sliding knot: Modified suture technique for scleral fixation using the corneoscleral pocket

“…Hoffman et al 1 described an ingenious technique for scleral fixation of a CTR/IOL without conjunctival dissection. By initiating a half-corneal-thickness incision inside the limbus, posteriorly directed dissection creates a partial-thickness scleral pocket through which sutures passing from the CTR/IOL within the eye to the conjunctival surface are retrieved for tying.…”

Late in-the-bag intraocular lens dislocation requiring explantation: risk factors and outcomes

“…4,6 Most authors agree that it is desirable to preserve and reposition the existing IOL if possible in order to avoid a large corneal wound, thus minimizing surgical trauma and major complications such as choroidal expulsive hemorrhage. 1,[28][29][30] However, in some advanced dislocations, explantation is the only valid alternative.…”

Choices in Correction of Aphakia during Vitrectomy

“…The scleral pocket is a newer technique described by Hoffman et al [7] in 2006, allowing for suture burial within the sclera without the need for conjunctival peritomy or preparation of a scleral flap. Two 30-degree peripheral clear corneal incisions are made 180° apart to a depth of between 300 and 400 µm (much like limbal relaxing incisions).…”