Scleral tunnel with conjunctival autograft for rescue management of extruded haptic

Abstract

Extrusion of haptic is a rare complication after intra-scleral haptic fixation of intraocular lens (SF-IOL). Various techniques described for its management such as autologous scleral patch, cauterization of exposed haptic, reattempting the glued IOL and IOL explant have their own limitations. Presently, we describe a simple rescue technique for management of such situations. In this method, after performing localized conjunctival peritomy, 2 mm long partial-thickness scleral tunnel is fashioned with an angled 20-guage microvitreoretinal blade 1.5 mm away from the limbus in line with pre-existing defective scleral flap underneath which the exposed haptic is tucked securely. Following this, conjunctival autograft (CAG) with fibrin glue application is undertaken to combat conjunctival fibrosis. In three patients, where this technique was performed, had well-tucked haptic and maintained visual acuity with no complications at 3-months follow-up. This technique is a useful method of tucking extruded haptic after SFIOL in eyes subjected to multiple previous surgeries.

The SWISS IOL Technique (Small-Width Incision Scleral Suture): A Mini-Invasive Technique

“…When considering the haptics of sulcus IOLs, their designed position is within the sulcus with their extremities being curved toward the back and the center of the eye. If they are placed outside of this position, they will exert a counterpressure and, as a result, tilting/decentration of the IOL's optic or haptic extrusion might happen [ 16 , 17 ]. Placing the haptics in their “physiological” position with 2 threads of 10-0 polypropylene guarantees a central position of the IOL with no tilting or instability.…”