Abstract
Purpose. To describe and explore an alternative approach for sulcus intraocular lens (IOL) implantation in the absence of capsular support. Methods. The commonly available one-piece poly(methyl methacrylate) (PMMA) lens is stabilized in the sulcus by two intraocular horizontal strings of 10/0 polypropylene suture passed through the lens dialing holes in opposite directions to achieve a mechanical balance. The horizontal strings of 10/0 polypropylene work as a rail track for the IOL optics, allowing some side to side lens adjustment even following wound closure. The stability of the IOL was tested in vitro. Six aphakic patients underwent in-sulcus IOL secondary implantation using the balanced two-string technique. Patients were followed up for a minimum of six months. Best spectacle corrected vision was assessed. Lens centration and lens tilt were measured by anterior segment optical coherence tomography (AS-OCT). Results. All patients had successful lens insertion. Best spectacle corrected visual acuity (BSCVA) improved in all patients. Lens decentration ranged between 0.21 mm and 0.9 mm (average 0.53 mm). Lens tilt ranged between 1.2° and 2.8° (average 2.17°). Conclusion. The mechanically balanced two-string technique is an alternative option for sulcus IOL implantation in absence of capsular support, allowing lens centration adjustment with no additional risks.
Highlights
In the absence of capsular support intraocular lens (IOL) implantation behind the iris plane is still possible with various scleral fixation techniques [1, 2]
Variable approaches for scleral fixation are described in literature with common documented difficulties: lens tilt, decentration, and sutures related complications [2, 4, 8, 12]
The IOL is suspended in the ciliary sulcus through its optics by two horizontally placed strings passing through the lens dialing holes
Summary
In the absence of capsular support intraocular lens (IOL) implantation behind the iris plane is still possible with various scleral fixation techniques [1, 2]. Lens decentration, lens tilt, and sutures related complications are known encountered difficulties with sclera fixated IOL (SFIOL) [3,4,5]. More points of fixation allow greater stability with less risk of decentration and tilt [6], there are greater risk of complications from multiple sutures passing through the sclera and the uvea [7]. The widely available one-piece PMMA lens was stabilized in the sulcus by two 10/0 polypropylene horizontal strings. These strings were passed in a mechanically balanced way through the lens dialing holes. The technique addresses lens decentration, tilt, and sutures related complications
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