Scleral Fixation Technique Research Articles

Closed-loop Scleral Fixation with 4-eyelet Intraocular Lens Implantation for Aphakia: Clinical Outcomes

Purpose: We present a modified, closed-loop scleral fixation technique. We inserted a 4-eyelet intraocular lens (IOL) into the anterior chamber prior to fixation. We investigated the clinical results.Methods: We retrospectively reviewed 39 eyes (39 patients) that underwent modified four-point scleral fixation of an inserted lens in our center from May 2019 to June 2022. The surgical procedure features conjunctival peritomy, 4-eyelet IOL insertion, eyeball penetration using a 9-0 polypropylene needle, eyelet placement using an ab externo technique to form a continuous loop, centering of the optic, and tying of a knot. We compared preoperative and 6-month postoperative changes in best-corrected visual acuity (BCVA), intraocular pressure, and refraction errors, and described postoperative complications.Results: The mean patient age was 62 years. The indications for surgery included complicated cataracts (20.5%), aphakia (20.5%), staged surgery for complicated cataract (12.8%), non-traumatic IOL dislocation (30.8%), traumatic IOL dislocation (12.8%), and crystalline lens dislocation (5.1%). The postoperative BCVA (0.40 logarithm of the minimum angle of resolution [logMAR]) was significantly better than the preoperative BCVA (0.69 logMAR) (<i>p</i> = 0.018). The postoperative spherical equivalent and the target diopter measurement were in high agreement (<i>p</i> = 0.002, intraclass correlation coefficient = 0.616). All of ocular hypertension (7.7%), hypotony (5.1%), bullous keratopathy (5.1%), and macular edema (5.1%) were noted, but 78% of the conditions improved with short-term medication. There was no re-dislocation of a fixated IOL.Conclusions: Our surgical technique simply and rapidly treats aphakia. Optic repositioning was easy, the IOL stability high, and the risk of complications during IOL fixation low.

Modified Four-Point Scleral Fixated Sutured Posterior Chamber Intraocular Lens Implantation Using 2 Eyelets Polymethyl Methacrylate Lens and 8-0 Polypropylene Suture.

To present a modified technique of 4-point scleral fixation using polymethyl methacrylate (PMMA) 2 eyelets intraocular lens (IOL) with 8-0 polypropylene sutures. A 270-degree conjunctival peritomy is done, and 4 sclerotomies (2 nasal and 2 temporal) are created. Lamellar scleral or clear corneal incision is made at superior site (6 mm wide for sclera or 5.5-6 mm for corneal). A short segment of 8-0 polypropylene is inserted into each eyelet, each thread of the suture is externalized through the sclerotomy site, and the lens is inserted. The suture is tightened evenly, and the knot is rotated and internalized. Scleral incision and conjunctival peritomy are sutured with 8-0 vicryl. We have performed this technique in 6 patients with excellent visual outcomes and no reported complications over 1 year of follow-up. This technique has practical advantages including rigid and stable PMMA IOL, high tensile, and slim 8-0 polypropylene suture which is easily internalized and less irritated, and affordable and widely available overall consumables. We present a modified 4-point scleral fixation technique for posterior chamber IOL placement using PMMA IOL with 2 eyelets and 8-0 polypropylene as compared to previous studies that used foldable IOL with 4 eyelets and 10-0 polypropylene or Gore-Tex sutures. This procedure has moderate technical complexity, comparable to previously reported techniques with good overall clinical outcomes and several practical advantages, particularly related to the affordability and availability of the consumables.

Results of Secondary Implantation by Sutureless Scleral Fixation Carlevale Intra Ocular Lens: A Prospective Study of 15 Cases

Implantation of an intraocular lens (IOL) in the capsular bag is considered the gold standard in cataract surgery. However, ophthalmologists often face patients with aphakia or insufficient capsular support following complicated cataract surgery, trauma or various zonulopathies. In such cases, the implantation of an IOL in the capsular bag is risky or impossible. Managing this type of patients remains a real challenge for surgeons, despite the considerable progress made in secondary implantation techniques. Lately, the new Carlevale Sutureless scleral fixation implant has enlarged this therapeutic arsenal, establishing itself as an attractive alternative for secondary implantation, offering good functional results with a low complication rate. We conducted a prospective interventional study including 15 eyes diagnosed with aphakia, subluxation or dislocation of an intraocular implant. All our patients consulted in the ophthalmology department of Jacques Coeur hospital in Bourges between November 2020 and November 2021. Our patients underwent secondary implantation surgery by Sutureless scleral fixation technique (SSF) with a Carlevale-type lens (Soleko, Italy). The post-operative follow-up was adjusted to the evolution of each case, with a minimum of 12 months' follow-up. It included at each visit the assessment of the best corrected visual acuity (BCVA), refraction, Intra-ocular pressure, clinical ophthalmic examination and endothelial cellularity count. The mean age of our patients was 76 ± 13.5 years, with a slight male predominance (53%). The indication for the secondary implantation surgery was the presence of aphakia in 60% of cases. IOL subluxation was noted in 33% of cases, while the remaining 6% concerned intraocular implants dislocated in the vitreous cavity. Mean best corrected visual acuity (BCVA) was 0.7 ± 0.25 log MAR preoperatively and 0.15 ± 0.33 log MAR at one year postoperatively, representing a mean gain of 5 lines on the Snellen scale. ........

Comparison of three different intraocular lens implantation techniques in the absence of capsular support: sutured scleral, haptic flanged intrascleral, and four flanged intrascleral fixations.

After lens extraction, if the capsular bag insufficiency occurs, there are different IOL implantation techniques. IOL implantation in the posterior chamber is safer in eyes with low endothelial cell count, peripheral anterior synechiae, shallow anterior chamber, and glaucoma. Alternative approaches for scleral fixation techniques, both with and without sutures, continue to undergo development. In this study, we aimed to compare the postoperative outcomes of the sutured scleral fixation (SSF), haptic flanged intrascleral fixation (HFISF) and four flanged intrascleral fixation (FFISF) IOL implantation techniques in eyes with the absence of capsular support. A hundred and thirty-seven aphakic eyes with the absence of capsular support were included in the study. The patients were divided into three groups: group 1-SSF, group 2-HFISF (Yamane technique), and group 3-FFISF. Surgical time in minutes, preoperative and postoperative parameters such as best corrected visual acuity (BCVA), corneal astigmatism, lenticular astigmatism, intraocular pressure (IOP), specular microscopy, central macular thickness (CMT) were recorded. Pseudophacodonesis was assessed at 6months postoperatively using a slit lamp, and early and late complications were recorded. Of the 137 eyes, 69 eyes were included in the SSF group, 41 eyes in the HFISF group, and 27 eyes in the FFISF group. No statistically significant differences were observed among the three groups in terms of age, gender, preoperative mean BCVA, corneal astigmatism, IOP, endothelial cell density, and CMT. It was observed that the mean BCVA significantly improved compared to the preoperative visual acuity in all three groups. Postoperative lenticular astigmatism, pseudophacodonesis score, percentage of the endothelial cell loss were found to be higher in FFISF groups. The surgical time was found to be shorter in the HFISF group. IOL decentration was observed in 1.44% of the SSF group and 7.40% of the FFISF group. Cystoid macular edema was observed in 5.79% of the SSF group, 4.87% of the HFISF group, and 7.40% of the FFISF group. Retinal detachment was observed in 1.44% of the SSF group and 7.31% of the HFISF group. The optimal technique for treating aphakia without capsular support remains uncertain. Surgeons are tasked with a complex decision, aiming for both excellent vision and minimal risk. This decision is based on their expertise, the distinctive ocular condition of the patient, and the availability of essential operating room equipment. In this study, the following findings were observed: in the HFISF technique, the average surgical time was found to be shorter, the SSF technique demonstrated greater stability in terms of astigmatism and pseudophacodonesis and the FFISF technique was recognized for its relatively straightforward application method. It is important to note that the three IOL implantation techniques yielded comparable outcomes in terms of postoperative BCVA, as well as early and late complications.

Evolution of Scleral Fixation, Haptic Externalization and Tucking Techniques

Phakic rehabilitation poses challenges for patients without capsular support, making traditional intraocular lens (IOL) implantation difficult. In such cases, an Anterior Chamber (AC) IOL or a scleral-fixated posterior chamber IOL (SF-PC IOL) can be considered as options. To ensure a well-centered IOL, haptics should be away from the ciliary processes, iris, and oraserrata, with sufficient distance from the iris to prevent capture. Delayed IOL dislocation can occur due to suture breakage, but it can be prevented by proper IOL size and snugly opposing the stitched haptics into the ciliary sulcus.

Four-flanged polypropylene optic piercing technique for scleral fixation of multifocal intraocular lens

BackgroundTo evaluate the feasibility of creating flanges using an optic piercing technique with a 6 − 0 polypropylene monofilament for scleral fixation of dislocated one-piece diffractive multifocal intraocular lenses (IOLs).Study DesignExperimental study and case series.SubjectsOptical bench test and eyes with IOL dislocation.MethodsTwo separate 6 − 0 polypropylenes were penetrated twice at the opposite peripheral optic of the TECNIS Synergy IOL (Johnson & Johnson Vision). The root mean square of the modulation transfer function (MTFRMS), at between + 1.00 and − 4.00 D of defocus, was measured in the TECNIS Synergy IOL both with and without optic piercing in the optical bench study. This case series included three eyes from two patients who underwent scleral-fixation of multifocal IOLs using the four-flanged polypropylene optic piercing technique. The postoperative corrected distance visual acuity (CDVA) at 4 m, the uncorrected near visual acuity (UNVA) at 40 cm, and IOL centration were evaluated.ResultsThe optical bench test showed no differences in MTFRMS values measured in the TECNIS Synergy IOL, either with or without optic piercing at all defocuses. In all three case series, the postoperative CDVA at 4 m was 20/20 and UNVA at 40 cm was J1. Postoperative anterior segment photographs showed good centration of IOLs in all cases.ConclusionThe four-flanged polypropylene optic piercing technique for multifocal IOL scleral fixation can provide excellent clinical outcomes and IOL stability after surgery without diminishing the performance of the multifocal IOLs.

Four-flanged Technique for Scleral Fixation of a Dislocated Four-eyelet Intraocular Lens

Purpose: To define and evaluate the short-term clinical outcomes of the four-flanged technique for scleral fixation of a dislocated four-eyelet intraocular lens (IOL).Methods: Eleven eyes of 11 patients who underwent scleral fixation of dislocated four-eyelet intraocular lenses using a four-flanged technique were studied retrospectively. We measured the best-corrected visual acuity (BCVA), corneal endothelial cell density, intraocular pressure (IOP), spherical equivalent, astigmatism, IOL tilt and decentration, and postoperative complications.Results: The BCVA was 0.25 ± 0.11 logarithm of the minimal angle of resolution (logMAR) before surgery and 0.14 ± 0.12 logMAR 6 months later (<i>p</i> < 0.001). The corneal endothelial cell count was 2,427 ± 384 and 2,367 ± 298/mm<sup>2</sup> before and after surgery, respectively (<i>p</i> = 0.285). The spherical equivalent was 6.02 ± 4.90 and 0.11 ± 0.36 before and after surgery, respectively. There was no significant difference in astigmatism before and after surgery. The mean IOL tilt and decentration were 2.44 ± 1.68° and 0.23 ± 0.09 mm, respectively. The refractive difference was 0.11 ± 0.24 diopters (D). Postoperative complications occurred in one eye; one flange lay outside the scleral tunnel, triggering hyperemia and conjunctival inflammation.Conclusions: The four-flanged scleral fixation technique for a dislocated four-eyelet IOL improved the BCVA but did not significantly affect corneal endothelial cell loss. The procedure significantly reduced postoperative IOL tilt, decentration, and astigmatism, and may be a useful alternative to scleral fixation of a dislocated four-eyelet IOL.

A Novel Technique for Scleral Fixation of an Intraocular Telescopic Device

A Novel Technique for Scleral Fixation of an Intraocular Telescopic Device

Double flanged prolene intrascleral fixation of Cionni capsule tension ring

Background Transconjunctival intrascleral fixation using double flanged prolene suture was used for scleral fixation of intraocular lenses (IOLs), Cionni capsule tension ring, and Ahmed segment. This technique carries the risk of flange exposure with subsequent hypotony and inflammation. Aim This study aimed to evaluate the efficacy of combining the Hoffman pocket with the traditional technique of Cionni ring scleral fixation in the prevention of flange exposure. Patients and methods This is a prospective study that included nine cases in which scleral fixation of the Cionni ring was indicated to treat severe zonular dialysis due to pseudo-exfoliation syndrome. The patients were followed up on the first day, after 1 week, and monthly for 6 months. During each postoperative visit, slit lamp biomicroscopy was performed to evaluate the status of the cornea, IOL centration, and position of the prolene flanges. Uncorrected visual acuity and best-corrected visual acuity were recorded. Results The mean best-corrected visual acuity improved significantly from 0.21±0.1 preoperatively to 0.76±0.24, 6 months postoperatively (P=0.0056). In all cases, the IOLs were well-centered and stable all through the postoperative follow-up period which ranged from 6 to 8 months (mean=6.9±0.66 months). No hypotony or endophthalmitis were reported. Conclusion The use of the Hoffman pocket to bury the terminal flanged ends of prolene sutures proved to be an efficient method to decrease the risk of conjunctival erosion and flange exposure.

Observation of the curative effect of scleral suture fixation technique with four-loop foldable intraocular lens.

The objective of the study was to evaluate the curative effect of a modified technique of scleral suture fixation with a four-loop foldable intraocular lens (IOL) for eye with inadequate capsule support. This was a retrospective study of 22 eyes with inadequate capsule support of 20 patients who underwent the scleral suture fixation technique with 9-0 polypropylene suture and foldable four-loop IOL implant. Preoperative and follow-up data were collected for all patients. The mean follow-up was 5.08 ± 0.48 months (range: 3-12 months). The mean pre- and postoperative log of minimum angle of resolution (logMAR) uncorrected distance visual acuity was 1.11 ± 0.32 versus 0.09 ± 0.09 (P < 0.001). The mean pre- and postoperative logMAR best corrected visual acuity was 0.37 ± 0.19 versus 0.08 ± 0.07 (P < 0.001). The intraocular pressure (IOP) increased briefly (range: 21-30 mmHg) in eight eyes on the first day postoperatively and returned to normal within 1 week. No IOP drops were used postoperatively. The IOP was 12-19.3 (13.72 ± 1.28) in this follow-up, which had no significant difference compared to the preoperative IOP (t = 0.34, P = 0.74). At this follow-up, there was no hyperemia, local hyperplasia, obvious scar, suture knots, or segment ends observed under the conjunctiva, as well as no pupil deformation or vitreous hemorrhage. The mean postoperative IOL decentration degree was 0.22 ± 0.08 mm. At the 7-day follow-up postoperatively, one side of the IOL was dislocated to the vitreous cavity in one case, which was resolved by reimplantation of a new IOL in time with the same technique. Scleral suture fixation technique of a four-loop foldable IOL was a feasible operation method for an eye with inadequate capsular support.

Commentary: When in a fix, rely on four-point intraocular lens fixation.

This study[1] on Observation of the curative effect of scleral suture fixation technique with four loop foldable intraocular lens is appreciable as it deals with a difficult technique, which has been described and illustrated well in the manuscript. Every ophthalmologist encounters the problem of inadequate capsular support, whether preoperative or intraoperative. It is imperative and crucial to learn how to tackle it and fix an intraocular lens (IOL) to provide good postoperative vision. As polypropylene sutures are non-absorbable, the 9-0 sutures used in this study have the advantage of a greater diameter and cross-sectional area than 10-0 polypropylene suture and will provide permanent wound support; the color blue helps in easy identification and the tensile strength is excellent.[2] Published studies on the use of 9-0 polypropylene sutures in scleral fixation of IOLs are very few.[3] The four-point IOL fixation to fixate the four haptics has been reported to provide a variety of advantages, including enhanced IOL stability and centration, avoidance/minimal of IOL tilt or postoperative pupil capture, and posterior segment complications.[4,5] However, there are a few concerns: The follow-up appears to be too short, with a range of 3–12 months, compared to other studies.[6,7] In eight eyes of this study, having elevated IOP, no medication was used though the IOP stabilized within a week. It may have been better to lower the IOP in the initial stages to prevent any damage. The central corneal thickness and applanation tonometry for the corrected IOP would have added further value. In one patient, it is mentioned that one side of the IOL was dislocated into the vitreous, yet another IOL was implanted and secured by the same technique. In statistical analysis ;newer version of SPSS formula would have been better to use instead of SPSS 16.0. The measurement of IOL tilt has been done at only one month postoperatively in the study. The postoperative endothelial count could have been compared to the preoperative count to provide more valuable insight. The postoperative UCVA was 0.09 ± 0.09, which was significantly better than the preoperative UCVA (t = 13.28, P < 0.001). The quality of vision further improved on correction, and postoperative BCVA was 0.08 ± 0.07, which was significantly better than preoperative BCVA (t = 6.89, P < 0.001). The potential drawback of the type of IOL used is that it is made of a hydrophilic acrylic material, in which opacification can occur. Cases having inadequate capsular support are not only complicated but require skill, expertise, and mentorship. When a surgeon is faced with such a patient, the onus lies only on them to give the best outcome. The importance of the study lies in the management of a complication or condition that can cause a devastating effect on vision. The difficult yet effective procedure described and analyzed is a valuable tool to a solution in a challenging situation.

One-Year Outcomes of Modified Technique for Scleral Fixation of a Three-Piece Intraocular Lens Without Conjunctival Opening.

PurposeThis study aimed to present the 1-year follow-up of a modified technique for scleral fixation of three-piece intraocular lens (IOLs) without conjunctival incision.Materials and MethodsA retrospective chart review of a consecutive series of 10 eyes of nine patients who underwent scleral IOL fixation using the modified technique was performed. Data were collected 1 year after surgery for all patients.ResultsThe range of follow-up time was between 1 year and 31 months. At the last follow-up point, the IOL was well-positioned and the visual acuity was good (as limited by primary diseases). Short-term complications included pupillary IOL capture (n = 1) and decreased intraocular pressure (n = 1), and no long-term complications were observed.ConclusionOutcome data support this technique as a viable option for the management of secondary IOL fixation with flexible usage of more designs of IOLs.

Long-term outcomes of modified glued versus flanged intrascleral haptic fixation techniques for secondary intraocular lenses.

To report the long-term refractive outcomes and complications of two scleral fixation techniques for secondary intraocular lenses (IOL). Consecutive patients who underwent secondary IOL insertion at a tertiary care academic hospital using either modified glued ("glued") or flanged intrascleral haptic fixation (FISHF) techniques with over 12months of follow-up were retrospectively reviewed. Pre- and postoperative corrected distance visual acuity (CDVA), postoperative complications, and refractive surprises were reported. Thirty-eight patients underwent "glued" fixation and 22 underwent FISHF, with mean follow-up times of 3.1 ± 0.5 and 2.0 ± 1.2years, respectively. Aphakia secondary to trauma was the main surgical indication. MA50BM or MA60AC IOLs (Alcon Laboratories Inc., Fort Worth, TX) were implanted in 92% of "glued" patients, while CT Lucia 602 IOLs (Carl Zeiss Meditec Inc., Dublin, CA) were used in 96% of FISHF patients. Postoperative spherical equivalent significantly improved compared to preoperative values (p < 0.001). No significant difference in CDVA was seen between the two techniques. FISHF resulted in mean hyperopic surprises of + 0.81D and + 0.69D using the Holladay 2 and Barrett Universal II formulae, respectively, which was significantly greater than the "glued" patients. A higher rate of IOL dislocation was seen in the "glued" cohort (13%) compared to FISHF (0%). Retrospective long-term outcomes of patients with complex ocular comorbidities undergoing a modified "glued" technique demonstrated a higher rate of IOL dislocation but more predictable refractive outcomes compared to the FISHF technique. The FISHF technique resulted in a significant hyperopic shift using fourth-generation IOL calculators.

Punch and rescue technique for scleral fixation of dislocated single-piece intraocular lenses.

In-the-bag intraocular lens (IOL) dislocation is a well-known complication after cataract surgery. As the number of cataract surgeries performed annually continues to increase, so will the incidence of IOL dislocations requiring surgical correction. Described is a new technique for rescue and refixation of a single-piece acrylic IOL. In this method, a new instrument called the IOL punch is used to create a hole at the optic-haptic junction or along the border of the optic, which acts as an anchor point for centration and subsequent scleral fixation of a dislocated IOL. The IOL punch allows for precise intraocular manipulation of the IOL and is less invasive compared with popular scleral fixation methods. This innovative technique may decrease the risk for postoperative complications and allows patients to maintain or recover previous uncorrected visual acuity by circumventing the need for IOL explantation or exchange.

Novel Sutureless Scleral Fixated IOL for Inadequate or Absent Capsular Support

Purpose To evaluate the clinical outcome and safety profile of a new sutureless scleral fixation (SSF) technique using a single-piece foldable acrylic Carlevale intraocular lens. Methods In this case study, 27 eyes of 27 patients were implanted with an SSF single-piece IOL because of inadequate or absent capsular support. The hand-shake technique used during surgery was combined with the creation of scleral pockets in order to secure the IOL haptics. The BCVA was evaluated in the 1st and 6th month in every patient and in the 12th and 24th months, when possible. Also, we evaluated the improvement achieved in spherical equivalent values from baseline to the 6th month after the procedure. Intraoperative and postoperative complications were assessed. Results The mean age was 69.1 ± 14.9 years, and the mean follow-up was 13.6 ± 4.8 months. Indications of scleral-fixated IOL included dislocated posterior chamber IOL (40.7%), dislocated anterior chamber IOL (11.1%), subluxated traumatic cataract (18.5%), subluxated nontraumatic cataract (18.5%), and aphakia (11.1%). Concurrent PPV was performed on eight of the eyes (32%). The mean preoperative logMAR BCVA increased from 0.85 ± 0.59 baseline to 0.44 ± 0.30 one month after surgery (p < 0.01) and 0.36 ± 0.34 (p < 0.003) six months after surgery. The baseline refractive status expressed in SE was 4.3 ± 6.4 D, and the postoperative status was −0.5 ± 0.99 D. Postoperative complications included vitreous hemorrhage (7.4%), hypotony (7.4%), transient IOP elevation (3.7%), and postoperative cystoid macular oedema (3.7%). The IOL was very well centered and stable in every case during the follow-up period. Conclusion The use of the SSF technique with implantation of a single-piece foldable acrylic Carlevale IOL seems to be a safe and effective alternative method that provides good preliminary results in cases where capsular support is inadequate or absent. Long-term stability results would be required to evaluate the benefit of this novel surgical approach in order to compare it with other existing methods.

Comparison of two techniques in posterior lens dislocations: Scleral suture fixation vs. modified Yamane intrascleral lens fixation

To compare the use of Yamane flanged intrascleral haptic fixation and scleral suture fixation (SSF) techniques in combination with pars plana vitrectomy (PPV) for treatment of posterior lens dislocations. Patients who underwent PPV and scleral fixated IOL implantation due to subluxation/luxation of the crystalline lens/intraocular lens (IOL) were included in this retrospective study. The Yamane group included patients who underwent Yamane flanged intrascleral haptic fixation technique, while the SSF group consisted of patients who underwent conventional SSF. All patients underwent comprehensive ophthalmologic examinations preoperatively and postoperatively. Intraoperative and postoperative complications were recorded. The Yamane group comprised of 39 eyes of 39 patients, and the SSF group included 35 eyes of 35 patients. Postoperative complications included hyphema (Yamane group: 2/39 (5.1%); SSF group: 0/35 (0%)) IOL decentration (Yamane group: 5/39 (12.8%); SSF group: 0/35 (0%)), corneal edema (Yamane group: 4/39 (10.2%); SSF group: 0/35 (0%)) cystoid macular edema (CME) (Yamane group: 1/39 (2.5%); SSF group: 3/35 (8.5%)) and retinal detachment (Yamane group: 1/39 (2.5%); SSF group: 1/35 (28.5%). The mean surgery time was significantly lower in the Yamane group compared with the SSF group (P<0.001). No cases of hypotony, conjunctival erosion, haptic exposure or endophthalmitis were encountered throughout follow-up. SSF remains a safe and effective technique for management of posterior lens dislocations. The Yamane intrascleral IOL fixation technique is an effective alternative to conventional SSF, which has a relatively steep learning curve. Postoperative complications, including IOL tilt and decentration, may be experienced in the initial cases.

Suture-needle snare for scleral fixation.

Current scleral suture fixation techniques pose challenges for highly complex eyes. A scleral suture fixation technique using a snare that is fashioned out of a 27-gauge needle and 8-0 nylon suture is described. This technique is well-suited for scleral suture fixation in complex eyes because it reduces risk factors for intraoperative and postoperative complications, simplifies intraocular maneuvers, minimizes surgical trauma, and does not require specialized microinstrumentation.

Management of late in-the-bag IOL dislocation with exchange and scleral fixation of IOL with the transfixion technique

Introduction: Late in-the-bag intraocular lens (IOL) dislocation is a serious complication of cataract surgery. Patient and clinical findings: A 70-year-old woman with a history of left eye cataract surgery presented with progressively decreasing vision that had worsened over the past 6 months. In the left eye, the uncorrected distance visual acuity (UDVA) was counting fingers at 5 m, the corrected distance visual acuity (CDVA) was 20/25 (+12.25 −1.25 × 180), and the intraocular pressure was normal. An anterior segment examination revealed severe inferior dislocation of the IOL-capsular bag complex. Diagnosis, intervention, and outcomes: The patient was diagnosed with late in-the-bag IOL dislocation and underwent IOL–capsular bag complex explantation with sulcus-sutured IOL implantation using a new scleral fixation technique that included transfixion of a foldable acrylic IOL with polytetrafluoroethylene suture. The postoperative outcome was good; the UDVA was 20/70, and the CDVA was 20/25, and there were no postoperative complications such as infection, suture erosion, iritis, uveitis, vitreous hemorrhage, or retinal detachment. Conclusions: Late in-the-bag IOL dislocation was safely managed with IOL–capsular bag complex explantation and scleral fixation of a foldable posterior chamber IOL. This transfixion technique can be used for scleral fixation in patients with late in-the-bag IOL dislocation.

Scleral Fixation of a Hydrophobic Acrylic Intraocular Lens with Eyelets Using 8-0 Polypropylene Suture.

PurposeTo report clinical outcomes of a scleral fixation technique of a hydrophobic acrylic intraocular lens with eyelets using 8-0 polypropylene suture.MethodsNine eyes of nine patients who underwent combined pars plana vitrectomy and sclera fixation of an intraocular lens using this technique were analyzed.ResultsThe mean follow-up period was 7.11 months (range, 6–12 months), and there was a significant visual improvement at 6 months after surgery. The mean logarithm of the minimum angle of the resolution changed from 0.54 at baseline to 0.29 at postoperative 6 months (p = 0.016). The mean postoperative spherical equivalent at 6 months was −0.90 ± 0.90 diopters, and the mean predictive error was −0.49 ± 0.62 diopters.ConclusionsPostoperative visual and refractive outcomes were favorable, and the positions of intraocular lenses were well centered in all cases. This technique could be a useful alternative for surgeons without easy access to Gore-Tex suture.

Exposed polypropylene flange in the Canabrava double-flanged polypropylene technique

Scleral fixation is a versatile surgical approach in the setting of lens bag instability. Recently, a double-flanged polypropylene technique to fixate the intraocular lens in the sclera has been described. A common concern in using any flanged scleral fixation technique is the risk of infection and endophthalmitis secondary to exposed fixation material, which can erode through the conjunctiva. In this report, a case of an exposed polypropylene flange presenting 1 month postoperatively in a 70-year-old female patient who underwent a 4-flanged fixation procedure is described. The successful surgical management of this case is described as well as other operative considerations to reduce the risk of exposed fixation material and subsequent postoperative infection. The correct placement of scleral fixation material as well as regular clinical review is vital in reducing the risk of postoperative endophthalmitis.