Surgical refixation of posteriorly dislocated intraocular lens with scleral-tuck technique

Abstract

Purpose:To report the outcomes of surgical refixation of posteriorly dislocated intraocular lens (IOL) using scleral-tuck method, and to compare the “scleral groove” and the “scleral flap” techniques used.Study Design:Single-center, retrospective, interventional, comparative study.Methods:Medical records of patients undergoing closed globe scleral refixation of posteriorly dislocated posterior chamber IOL (PCIOLs) by scleral-tuck method using two different techniques (”scleral groove” vs. “scleral flap” technique) were reviewed. This approach involved retrieving the dislocated PCIOL, externalizing the haptics through 2 sclerotomies created in paralimbal lamellar scleral grooves, or under lamellar scleral flaps and tucking the haptics into limbus-parallel scleral tunnels. No specific haptic architecture, haptic suturing, or large incisions were needed. Main outcome measures included best-corrected visual acuity (BCVA), final mean refractive error, and intra- and post-operative complications.Results:Thirteen eyes of 13 patients (scleral groove, n = 6; scleral flap, n = 7 eyes) with a mean follow-up of 20.6 months were included. BCVA in all eyes was maintained or improved postoperatively, with three eyes (23%) showing ≥2 line improvement. Median astigmatic error at 6-week follow-up was −1.25 D cylinder (range: −0.5 D–−2.0 D) which remained stable till final follow-up. All IOLs remained stable and well centered. None of the eyes had a recurrent dislocation, retinal detachment, endophthalmitis, or glaucoma. Both techniques were comparable in terms of postoperative BCVA, and refraction.Conclusion:Intrascleral haptic fixation by scleral-tuck method is reliable and effective for secure IOL refixation of posteriorly dislocated IOLs, providing good IOL centration and stability with minimal surgically-induced astigmatism. Both techniques (scleral groove and scleral flap) appear to have similar outcomes in the short term.

Management of the subluxated crystalline lens: A review

“…In the sutureless scleral fixation technique, the haptics are secured to the sclera directly by fixating the haptics with intrascleral flaps, 30 tunnels 31,32 or grooves 33 . In more recent years, the Yamane double needle technique 34 for sutureless transconjunctival intrascleral haptic fixation with flanged haptics has gained popularity.…”

Scleral-fixated intraocular lens implants—evolution of surgical techniques and future developments

“…transscleral suture fixation or sutureless intrascleral fixation) to determine if the original implant is suited to the surgical technique. A number of studies have looked at the outcomes following IOL rescue and refixation as well as comparing refixation with lens exchange to determine the most appropriate option for scleral fixation [19][20][21][22][23][24].…”

“…However, concerns regarding iris-touch and lens stability in the long term with a lack of specific one-piece lens designs for scleral fixation means that these are not widely used for SFIOL implantation. A retrospective, comparative study that compared two different surgical techniques to rescue dislocated IOL implants and fixate them with either vicryl sutures or fibrin glue reported no postoperative IOL dislocations or tilt and an improvement in overall visual acuity [20]. Another retrospective study comparing IOL refixation to lens exchange using perfluorocarbon liquid and fibrin glue found no difference in visual outcomes and complications between the two groups [21].…”

Simple Refixation of a Dislocated Haptic of Flanged Intraocular Lens Using a 25-Gauge Needle

“…Alternatively, owing to the unavailability of 30gauge thin-wall needles in some settings, a 27-gauge needle can be used to externalize the IOL haptic and has been adopted in the author's practice. Operative refixation of a posteriorly dislocated IOL by a sutureless method was described either by scleral groove and scleral flap technique 2,3 in the era before the Yamane technique. However, there have been insufficient studies of the management of a dislocated flanged haptic of an IOL.…”