Simplified and safe method of sutureless intrascleral posterior chamber intraocular lens fixation: Y-fixation technique

Abstract

We report a new surgical technique that allows intrascleral fixation of a posterior chamber intraocular lens (IOL) without sutures. The Y-fixation technique does not involve complicated intraocular manipulation and achieves safe sutureless fixation. A Y-shaped incision is made in the sclera and a 24-gauge microvitreoretinal (MVR) knife is used to create the sclerotomy instead of a needle. The Y-shaped incision eliminates the need to raise a large lamellar scleral flap and to use fibrin glue because the haptic can be fixed both inside the tunnel and in the groove, and performing the sclerotomy with the 24-gauge MVR knife simplifies extraction of the haptic and improves wound closure. There is no risk of infection from exposure of the haptic on the sclera and no use of fibrin glue. There was significantly less IOL decentration and tilt than with suture fixation.

Implantation of foldable posterior chamber intraocular lens in aphakic vitrectomized eyes without capsular support

“…Temporary IOH at 1-3 weeks and CME at 6 months completely resolved during the study period. These pos toperative complications have also been reported in similar previously-reported studies (13,(16)(17)(18)(19) . No significant difference in VA change was observed between groups in the present study (P=0.79) While there was no difference in preoperative VA, a statistical difference between postoperative VA values was observed between groups (P=0.003).…”

“…Two major methods of suture-free intrascleral IOL implantation have been reported in previous literature. In this technique, the haptics are fixated under scleral flaps using tissue adhesive glue (20)(21)(22) or into a narrow scleral tunnel parallel to the limbus (12)(13)(14)(15)(16)(17)(18)(19) . Fixation into the scleral tunnel has advantages, such as removing the requirement need for an additional tissue adherent or the use of scleral flaps.…”

“…During PPV, the iatrogenic removal of the lens capsule may be required depending on the etiology and severity of the vitreoretinal disease. Posterior chamber IOL implantation may be performed via posterior chamber transscleral fixation (1)(2)(3)(4)(5)(6)(7) , iris fixation (8)(9)(10)(11) , intrascleral fixation (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) , angle supported anterior chamber IOL (23,24) , or iris claw IOL implantation (25,26) . Advantages of PCIOL fixation include the distant position from anterior segment structures, such as the corneal endothelium, and proximity to the focal point of the eye where the lens is naturally si tuated.…”

“…In cases with no capsular support, the implantation of a foldable IOL can be performed through a small corneal incision into the posterior chamber with suture fixation to the sclera or iris (4)(5)(6)(7)(8)(9)(10)(11) . Alternatively, IOL implantation can be performed through a small incision to the posterior chamber with sutureless intrascleral fixation (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) . In the present study, we evaluated three separate groups of patients with vitrectomized aphakic eyes lacking capsular support in whom foldable IOL were implanted through a small corneal incision using either transscleral fixation, iris fixation, or intrascleral fixation.…”

Komparative Analyse von Sicherheits- und Funktions-Outcomes der anterioren versus retropupillaren Irisklauen-IOL-Implantation

“…Mögliche Ursachen für einen inadäquaten Kapselsack-Halteapparat und somit eine fehlende natürliche Stützstruktur sind eine komplizierte Kataraktchirurgie, Luxation der Augenlinse sowie eine Dislozierung oder Trübung einer älteren konventionellen IOL. Zur chirurgischen Korrektur in dieser Situation sind verschiedene Methoden beschrieben worden, zum Beispiel die Implantation einer speziellen IOL, die vom Kammerwinkel der Vorderkammer (VK) oder der Iris gestützt wird, oder einer an der Sklera fixierten IOL [1,2,3]. Irisgestützte IOL werden an der anterioren Fläche der Iris mit einem klauenförmigen Haptiksystem fixiert und wurden ursprünglich zur Korrektur der Aphakie verwendet [4].…”