Adjustable 6-0 polypropylene flanged technique for scleral fixation, part 1: primary fixation IOLs in aphakia, capsular stabilizing devices, and aniridia implants.

Abstract

To describe the technique and outcomes of modified adjustable flange intrascleral fixation using 6-0 polypropylene sutures in primary scleral fixation in a variety of intraocular lenses (IOLs) and capsular stabilizing devices. Center for Applied Eye Research, Meir Medical Center, Israel. Case series. Laboratory studies were performed to test the feasibility of passing 6-0 polypropylene sutures through hydrophobic and hydrophilic IOLs. The durability of the IOL, suture, and created flange was tested. IOL implantation was performed first on porcine eyes with assessment of IOL position. Surgery was then performed using this adjustable flange technique using a variety of IOLs, including hydrophilic, hydrophobic, and poly(methyl methacrylate) aniridic IOLs and the capsular anchor (AssiAnchor) to stabilize the capsular lens in eyes with compromised zonular fibers. Surgery was performed on 9 eyes. Both hydrophobic and hydrophilic IOLs together with the 6-0 polypropylene suture were sufficiently durable in laboratory tests. Intrascleral fixation of 3 hydrophobic IOLs and 1 hydrophilic IOL was successfully achieved in 4 aphakic eyes. Stable and secure capsular bag fixation using the AssiAnchor was achieved in 4 eyes. Fixation of an aniridia IOL was also performed with success in 1 eye. All cases had stable and securely fixated IOLs and good postoperative recovery at 3 months follow-up. There was improvement in uncorrected distance visual acuity postoperatively in all cases. The modified adjustable flange technique for scleral fixation using polypropylene 6-0 was effective, relatively quick, and technically simpler and safer than alternative methods in the management of aphakia and zonular instability.