Double rectangular suture sulcus reconstruction in the management of aphakia with absent capsular support

Abstract

Aim This study aimed to describe a new method of sulcus fixation of intraocular lenses (IOLs) with total or partial loss of capsular support. Materials and methods This was a prospective nonrandomized comparative clinical trial, where two groups were managed for IOL scleral fixation in the absence of capsular support. Group A included 12 cases with classic ab externo two-point sclera fixation and group B included 16 cases with the double rectangular suture sulcus reconstruction (DRSSR). The etiology of aphakia in group A included congenital cataract managed by lensectomy (three cases), trauma (six cases), and complicated phacoemulsification (three cases). In group B, aphakia was because of congenital cataract in two cases, trauma in five cases, hypermature cataract in three cases, and complicated phacoemulsification in two cases. A unique subset of group B included four eyes with posterior chamber IOL subluxation or dislocation managed by DRSSR. The main outcome measures included final best-corrected visual acuity (BCVA), lens stability, and complications. Results All 28 eyes had stable or improved BCVA and the mean postoperative BCVA had improved significantly from 6/30 to 6/7.5 (P = 0.004). There were no statistical differences between groups A and B in postoperative BCVA (P = 0.403), complications (P = 0.25), and astigmatism (P = 0.113). Group 2 B cases with subluxated and posterior dislocated IOLs were managed by DRSSR, with no need for exteriorizing the IOL, with excellent centration. Conclusion The DRSSR seems to be a safe method of providing an adequate bed for IOL stabilization in the absence of capsular support. This method is particularly useful in dislocated or subluxated IOLs that need repositioning under a closed globe with minimal manipulations.