Abstract
BackgroundThis report serves to describe the use of a novel adjustable single 8–0 polypropylene suture for scleral fixation without conjunctival dissection, and to describe related clinical outcomes associated with this approach.MethodsIn this study, we retrospectively reviewed 28 eyes from 27 patients that underwent scleral fixation of the intraocular lens (IOL) without conjunctival dissection using an adjustable single 8–0 polypropylene suture at the Beijing Tongren Eye Center between April 2018 and April 2019. For this surgical approach, a 23-gauge infusion cannula was set, after which two Hoffmann scleral pockets were created. Next, 8–0 polypropylene sutures were inserted into the eye guided by 10–0 polypropylene sutures of a long straight needle. The 8–0 suture was then used to fix the haptic IOs. Finally, these 8–0 polypropylene sutures were removed from the scleral pockets, and knots were tightened with the adjustable single suture. Primary outcomes included visual acuity and postoperative complication incidence.ResultsFor this study, outcomes for 28 eyes from 27 patients (9 female, 18 male) were assessed. Patients had a mean age of 54 ± 15.11 years-old and were followed for an average of 10.18 ± 2.76 months postoperatively. Uncorrected visual acuity in these patients improved significantly from a preoperative value of 1.269 ± 0.464 logMAR to a 3-month postoperative value of 0.409 ± 0.413 logMAR (p = 0.000). The majority of postoperative complications in these patients were temporary and self-limiting, including corneal edema (35.71%), hypotony (14.29%), elevated intraocular pressure (28.58%), and mild hyphema (7.14%). No evidence of exposure or erosion of the trimmed suture end was detected in any patients. An ultrasound biomicroscope was able to readily detect the IOL and all sutures, and IOLs were found to be well-centered without any dislocation, tilting, or subluxation upon follow-up.ConclusionsAn adjustable single 8–0 polypropylene suture can reliably and effectively be used for scleral fixation without conjunctival dissection for the treatment of patients with aphakia or inadequate posterior capsule support. The novel procedure described herein may therefore be an effective means of minimizing the risk of suture-related complications in patients undergoing scleral-fixated IOL implantation.Trial registrationRetrospective case series study, not applicable. NCT04476264.
Highlights
This report serves to describe the use of a novel adjustable single 8–0 polypropylene suture for scleral fixation without conjunctival dissection, and to describe related clinical outcomes associated with this approach
A number of surgical approaches have been employed for intraocular lens (IOL) implantation in eyes lacking posterior capsular support, such as anterior chamber IOL, iris-fixated IOL, sulcus-fixated IOL, and scleralfixated IOL implantation via suture-based or suture-free intrascleral fixation [1]
Transscleral suture-mediated IOL fixation was first described by Malbran in 1986 [2], and is a relatively common surgical approach owing to its low incidence of postoperative complications
Summary
This report serves to describe the use of a novel adjustable single 8–0 polypropylene suture for scleral fixation without conjunctival dissection, and to describe related clinical outcomes associated with this approach. Anterior chamber IOL implantation, is rarely conducted as it is associated with relatively high rates of complications such as glaucoma, limited pupillary mobility, chronic inflammation, and corneal decompensation. Transscleral suture-mediated IOL fixation was first described by Malbran in 1986 [2], and is a relatively common surgical approach owing to its low incidence of postoperative complications. Prior studies have described certain suture-related complications associated with this approach, including inflammation, suture erosion, and suture degradation [3, 4]. Efforts to prevent these complications have employed approached including the rotating of suture knots into the eye and covering suture ends with scleral pockets or flaps [5–9]. Researchers have utilized 8–0 polypropylene sutures as an alternative owing to their high tensile strength and comparatively lower susceptibility to degradation [10]
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