Sulcus Fixation without Flaps

Abstract

Numerous techniques for sulcus fixation of posterior chamber implants in the absence of capsular support have been reported. All rely on partial thickness scleral flaps or the conjunctiva to prevent the requisite polypropylene knot from eroding. The author compares their success with that of a new surgical procedure. This new technique buries the knot within the eye. One hundred scleral-sutured, sulcus-fixated cases were studied retrospectively. Each case was performed by the author or by a resident under this direction. Suture erosion was defined as the absence of scleral or conjunctival cover on part of the polypropylene suture. On 60 patients, partial thickness scleral flaps were used to protect the knot from exposure. Twelve (20%) of these patients had some degree of externalization of the suture. Of the 40 patients in whom knots were buried and no scleral flap was used, no (0%) erosion was observed. Sulcus fixation of posterior chamber knots has been criticized for increasing the risk of endophthalmitis. The track formed by an exposed suture allows an infectious agent to pass from the external eye to the supported intraocular lens (IOL). Scleral flaps add a degree of safety, but the knot can erode after several months. The author advocates burying the knot within the eye to avoid erosion and therefore endophthalmitis.