A modified intrascleral intraocular lens fixation technique with fewer anterior segment manipulations: 27-gauge needle-guided procedure with built-in 8\u20130 absorbable sutures

Yuan Yang,Teng-Teng Yao,Ya-Li Zhou,Zhao-Yang Wang,Yi-Xiao Wang

doi:10.1186/s12886-019-1239-2

Abstract

BackgroundTo report a modified surgical technique for intrascleral intraocular lens (IOL) fixation with fewer anterior segment manipulations in eyes lacking sufficient capsular support.MethodsEyes from 14 patients who underwent 27-gauge needle-guided intrascleral IOL fixation with built-in 8–0 absorbable sutures were studied. The 8–0 absorbable sutures were inserted into 27-gauge round needles and used to create sclerotomies at the 4 o’clock and 10 o’clock positions under the scleral flap. The sutures were used to tie knots at the end of each haptic and guide haptic externalization through the sclerotomy. After externalization, a sufficient flange was created at the end of each haptic and fixed under the scleral flaps. The best corrected visual acuity (BCVA), corneal endothelial cell density (ECD), IOL tilt and decentration, previous surgery history, and complications were determined.ResultsFourteen cases were analyzed. The majority of eyes exhibited an improvement in the BCVA after surgery. When comparing the last follow-up to preoperative visual acuity, the mean change in BCVA was + 26.32 letters (p = 0.011). Postoperative complications included postoperative hypotony in 3 eyes, ocular hypertension in 2 eyes. No cases of postoperative cystoid macular edema (CME), vitreous hemorrhage (VH), IOL dislocation, or endophthalmitis were observed.ConclusionsThe 27-gauge needle-guided intrascleral IOL fixation technique with built-in 8–0 absorbable sutures is easy to perform with fewer anterior chamber manipulations and achieves both anatomical and optical stability.

Highlights

To report a modified surgical technique for intrascleral intraocular lens (IOL) fixation with fewer anterior segment manipulations in eyes lacking sufficient capsular support
There are potential risks of the IOL falling into the vitreous cavity, haptic extrusion or exposure to the external environment, which might lead to endophthalmitis
The haptics were well fixed and the IOL was centrally positioned in all 14 eyes of 14 patients (11 males, 3 females; mean age, 45.86 ± 19.14 years old; range, 7–74 years old)

Summary

Introduction

To report a modified surgical technique for intrascleral intraocular lens (IOL) fixation with fewer anterior segment manipulations in eyes lacking sufficient capsular support. Sutureless techniques might result in haptic damage or dislocation from the intrascleral tunnel, but do not have suture-related complications These techniques are less time consuming, easier to perform, and retain the advantages of intrascleral IOL fixation [11, 12]. Several modifications to this technique have been reported [13,14,15] Among those techniques, Yamane developed a doubleneedle technique and a flanged IOL fixation technique; these two techniques can provide good IOL fixation with firm haptic fixation without using special surgical instruments and sutures. Yamane developed a doubleneedle technique and a flanged IOL fixation technique; these two techniques can provide good IOL fixation with firm haptic fixation without using special surgical instruments and sutures These two techniques have the advantages of being simple and requiring less surgical time [1, 2]. A longer learning curve might be required [19]

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