Trocar-assisted sutureless intrascleral posterior chamber foldable intra-ocular lens fixation

Abstract

Purpose We report a novel technique characterized by sutureless scleral fixation of three-pieces foldable intraocular lens (IOL) using 25-gauge transconjunctival sutureless vitrectomy (TSV) trocars in patients with insufficient posterior capsule support. Materials and Methods We performed this technique on the eight eyes of the seven patients. The scleral tunnels (STs) are prepared by insertion of the 25-gauge TSV microcannulas using the trocars, and anterior vitrectomy is performed through the clear corneal paracentesis with the aid of anterior chamber maintainer (ACM). Finally, the threepiece foldable IOL haptics are incarcerated into the prepared STs. Results The patients were followed up 5-8 months. None of the patients had complications such as postoperative endophthalmitis, glaucoma, IOL tilt or decentralization, and retinal detachment. Injection of a foldable IOL through a clear corneal small incision also contributes the less surgical-induced astigmatism. Conclusion The presented novel sutureless scleral IOL fixation technique may provide minimal trauma to the surrounding tissues, good IOL stabilization decreasing the incidence of IOL tilt along with shorter operation time, and postoperative quiet eye.

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

“…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.…”

Motorized injector‐assisted intrascleral intraocular lens fixation

“…This procedure avoids the disadvantage of suture degradation, has the advantage of posterior chamber placement and good IOL stability as well as less decentration or tilting postoperatively than other alternatives [5]. Many innovative variations [4,6–21] have been reported to improve certain steps, including the introduction of fibrin glue for wound closure (glued IOL technique) [6], the handshake technique for intraocular manipulation of the haptics [10], and the no‐assistant technique [12] for trailing haptic externalization.…”

Microincision Vitrectomy Trocars – Redefining Surgical Practices Through a New Range of Applications

“…The haptics are then incarcerated in scleral tunnels and left in place. 10 This technique is less time-consuming and provides less manipulation than the conventional scleral-suturing options. …”