A Modified Intrascleral Intraocular Lens Fixation Technique Using 27-Gauge Blunted Needles with Fewer Intraocular Manipulations.

Kazuya Morino,Masayuki Akimoto,Yuto Iida,Su-Ho Lim

doi:10.1155/2021/6791977

Abstract

A new method for intraocular lens (IOL) fixation in the scleral tunnel using two common 27G blunted needles and an ultrathin 30G needle with fewer intraocular manipulations was developed. Half-depth scleral flaps were prepared, and vertically angled sclerotomies were performed under each scleral flap, 2 mm from the limbs with a 20G microblade or a 26G needle. Two bent 27G blunted needles connected the sclerotomy and corneoscleral incisions. One haptic was inserted into this bent 27G blunted needle extraocularly and extruded through the sclerotomy site. Each haptic was inserted into the lumen of the preplaced ultrathin 30G needle and buried into the scleral tunnel. In this retrospective study, we reviewed the outcomes of this new technique in patients with at least 3 months' follow-up data. Iris capture of the IOL was not observed in any case, and IOL repositioning was not performed either. Astigmatism induced by intraocular aberration was almost as same as that with other methods. Our technique can be performed in any operation room without any extra instruments. This trial is registered with UMIN000044350.

Highlights

Implantation of an intraocular lens (IOL) in the absence of capsular support has been accomplished by using an anterior chamber (AC) IOL [1,2,3,4], iris-fixed IOL [5,6,7], and intrascleral fixed posterior chamber (PC) IOL [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26]
In all cases of IOL dislocation, the IOLs were replaced because they were single-piece acrylic IOLs. e ends of haptics were flanged in three cases (15%). e mean patient age at the time of surgery was 67.2 ± 14.3 years
A representative image of the anterior segment of the eye after the surgery is shown in Figure 2(l). e astigmatism induced by intraocular aberration was −0.65 ± 0.34 D. e mean (standard deviation (SD)) IOL tilt was 7.5 ± 3.8°. e mean (SD) preoperative and postoperative corneal endothelial cell densities were 2471 ± 666 cells/mm2 and 2006 ± 632 cells/mm [2], respectively. e mean (SD) corneal endothelial cell density loss 3 months postoperatively was −11.0 ± 13.8%

Summary

Introduction

Implantation of an intraocular lens (IOL) in the absence of capsular support has been accomplished by using an anterior chamber (AC) IOL [1,2,3,4], iris-fixed IOL [5,6,7], and intrascleral fixed posterior chamber (PC) IOL [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26]. Sutureless techniques for intrascleral fixation of IOL are gaining popularity among ophthalmic surgeons because of lesser incidence of corneal endothelial cell loss, glaucoma, and peripheral anterior synechiae [1,2,3,4], despite the invention of new techniques of retropupillary iris-fixed IOL fixation over the past few years [5,6,7]. Some difficulties in intraocular manipulation, angled sclerotomy, and lens position adjustment without special guidance tools are experienced. Because of these factors, we often observe IOL dislocation or exposure of the flanged haptic, and it is sometimes difficult to reposition the IOL (Figures 1(a) and 1(b)). We report a modified method for the intrascleral fixation of IOL, which can be performed extraocularly by navigation of the anatomical markers using two commonly used 27G blunted needles used for viscoelastic material injection and an ultrathin 30G needle. is technique requires fewer intraocular manipulations than the doubleneedle-flanged technique

Materials and Methods

Results

Conclusions