Is this really sutureless scleral intraocular lens fixation?

Abstract

In their recent article, Ohta et al.1 describe a technique of sutureless intrascleral fixation of a posterior chamber intraocular lens (IOL). This definition does not seem to be correct. As the authors fixated the haptics in the scleral bed in the scleral groove using a nonabsorbable suture to prevent slippage, this is a modified sutured technique. If they had used an absorbable suture, the definition would apply. Ohta et al.1 stated that they encountered difficulty placing the haptics in the scleral tunnel with the 24-gauge needle technique of Gabor et al.2 We agree with the authors because placement of the haptics using this technique may be difficult in some cases. Therefore, we developed the trocar-assisted sutureless intrascleral fixation IOL method.3 In previously reported techniques of sutureless intrascleral fixation, a nonabsorbable suture was not used.2–5 In our trocar-assisted technique, we placed a nonabsorbable suture transconjunctivally after placing the haptics in the scleral groove for stabilization during the early postoperative period and removing it 1 week later.3 Ohta et al. obtained a triangular-shaped flap.1 They did not mention how much of the haptics were inserted into the scleral bed. Despite a permanent suture, they reported IOL-related complications as 5%,1 which is higher than the rates in previous studies2–5 of sutureless intrascleral IOL fixation (0% to 4.8% except traumatic dislocations). The authors concluded that their technique was more secure and simpler than the others. We do not agree with this for the reasons mentioned above. Our trocar-assisted technique appears to be simpler and quicker.3,4 In conclusion, the technique that Ohta et al. presented may be considered a modified intrascleral fixation of the IOL rather than a sutureless method. In this technique, the main procedure ensuring IOL stability is the use of a permanent suture.