Sutureless Intrascleral Haptic-Hook Lens Implantation Using 25-Gauge Trocars.

Zhi-Xiang Hu,Haishuang Lin,Tianyu Chen,Rong-Han Wu,Lingying Ye,Ke Lin,Zhong Lin

doi:10.1155/2018/9250425

Abstract

Purpose To report a new technique for sutureless intrascleral fixation of three-piece foldable intraocular lenses (IOLs) using 25-gauge trocars. Methods We performed this technique on patients with insufficient posterior capsule support. Seventeen eyes from 15 patients with aphakia, dislocated IOL, or subluxated crystalline lens undergoing posterior chamber sutureless implantation of an IOL were studied. The haptics of the IOL were externalized using two 25-gauge forceps. The haptics were bended back (hook-like) into the vitreous cavity through a scleral incision made by using a 25-gauge trocar. And, IOL tilt was determined by using a slit lamp and UBM, and complications were recorded. Results The IOLs were fixed with exact centration and axial stability. No wound leakage was reported even without the use of sutures. The mean best-corrected visual acuity (BCVA) was 0.82 logarithm of the minimum angle of resolution (logMAR) units preoperatively, and the mean BCVA was 0.44 logMAR units at the 6-month follow-up visit. No postoperative retinal detachment, endophthalmitis, IOL tilt or dislocation, or vitreous hemorrhage was noted. Conclusion Sutureless intrascleral haptic-hook posterior chamber IOL implantation using 25-gauge trocars provides good IOL fixation with reliable wound closure without the use of sutures. This trial is registered with ChiCTR1800017436.

Highlights

Intrascleral fixation of posterior chamber (PC) intraocular lens (IOL) has become more popular, as it has advantages such as minimal trauma to the surrounding tissues, good intraocular lenses (IOLs) stabilization decreasing the incidence of IOL tilt along with shorter operation time, and does not require degradable threads which may lead to long-term extraconjunctival exposure [1,2,3,4,5]. e various intrascleral fixation techniques have critical differences in the manner in which the haptic of the IOL is handled [6]
Our modified sutureless technique was performed in 15 patients. e technique was combined with vitrectomy to partially or entirely remove the vitreous in all patients. e mean best-corrected visual acuity (BCVA) was 0.82 logarithm of the minimum angle of resolution (logMAR) units preoperatively and 0.44 logMAR units at the 6-month visit (Table 1)
Stability of the haptic of the IOL has been reported to be the area of most concern in long-term visits [12]

Summary

Introduction

Intrascleral fixation of posterior chamber (PC) intraocular lens (IOL) has become more popular, as it has advantages such as minimal trauma to the surrounding tissues, good IOL stabilization decreasing the incidence of IOL tilt along with shorter operation time, and does not require degradable threads which may lead to long-term extraconjunctival exposure [1,2,3,4,5]. e various intrascleral fixation techniques have critical differences in the manner in which the haptic of the IOL is handled [6]. Agarwal et al and Oh et al have reported the use of fibrin glue-assisted sutureless IOL scleral fixation combined with scleral flaps for the implantation of PC-IOLs [7, 8]. Takayama et al have described a modified technique where the IOL haptics are incarcerated into the prepared scleral tunnels instead of a scleral flap, which provides stability for the PC-IOLs [9]. We modified the haptic fixation to increase the stability of the IOL haptic by bending the haptics back into the vitreous cavity by 25-gauge vitrectomy to minimize the scleral incisions. We performed this modified technique in a series of eyes with aphakia, dislocated IOL, or subluxated crystalline lens. We report a case series of this technique and its clinical results

Methods

Results

Conclusion