Implementation of the posterior chamber intraocular lens intrascleral haptic fixation technique (glued intraocular lens) in a United States practice: Outcomes and insights

Abstract

Purpose: To evaluate intrascleral haptic posterior chamber intraocular lens (PC IOL) fixation (glued IOL).

Setting: North American tertiary referral center, private practice.

Design: Noncomparative interventional case series.

Methods: A retrospective review of early cases of the technique performed at the same center evaluated outcomes and complications. Based on early experience, 2 modifications were made to the standard technique. The first was to transition to IOLs with more flexible and resilient haptic materials than poly(methyl methacrylate) or polypropylene. Second, the scleral flap was created with a diamond knife and only 2 edges were lifted, leaving the side adjacent to the tunnel uncut. This allowed reliable creation of a scleral tunnel at equal depth to the flap bed and improved ease of subsequent haptic enclavation; it also strengthened the anterior aspect of the tunnel entrance.

Results: Fifty PC IOLs were successfully placed with intrascleral haptic fixation by 1 of 3 experienced surgeons to treat a variety of IOL complications or aphakia. Two cases involved the successful placement of iris prostheses. Staged endothelial keratoplasty was performed in 11 cases without complication. No IOL dislocated, decentered, or was unstable. Self-resolving hypotony occurred in 11 eyes (22%). The median visual acuity improved from 20/200 to 20/50.

Conclusions: The glued IOL technique reliably provided secure IOL fixation in the absence of capsule support and successfully treated a variety of IOL complications, aphakia, and aniridia. Minor technique modifications minimized some difficulties associated with this surgery.