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. 2019 Aug 18;12(8):1283-1289.
doi: 10.18240/ijo.2019.08.08. eCollection 2019.

Evaluation of suturless scleral fixation with posterior chamber foldable intraocular lens implantation

Ahmed M Bedda  1 , Hesham F ElGoweini  1 , Ahmed M Abdelhadi  1 , Amr M Elhady  2
Affiliations

Evaluation of suturless scleral fixation with posterior chamber foldable intraocular lens implantation

Ahmed M Bedda et al. Int J Ophthalmol. .

Abstract

Aim: To assess the sutureless scleral fixation technique for posterior chamber foldable intraocular lens (PCIOL) implantation in aphakic eyes with insufficient or no capsular support.

Methods: A technique for sutureless intrascleral fixation of the haptics of a standard 3-piece PCIOL was used which ensures sutureless fixation by permanent incarceration of the haptics in a scleral tunnel parallel to the limbus. All patients were evaluated for preoperative status [visual acuity, refractive error, K readings, intraocular pressure (IOP) measurement, slit lamp examination, fundus examination and optical biometry], postoperative status and complications. Ultrasound biomicroscopy (UBM) was done for 10 cases to evaluate optic tilt.

Results: The study evaluated 42 eyes of 42 patients. The follow-up period was 6mo. Improvement of best corrected visual acuity (BCVA) one line occurred in 10 cases (23.8%) and loss of one line in 3 cases (7.1%). Intraoperative complications included: haptic kink in 4 cases (9.5%), haptic breakage in 1 case (2.4%), haptic dislocation in 1 case (2.4%), haptic slippage in 3 cases (7.1%), IOL dislocation in 1 case (2.4%) and sclerotomy related bleeding in 1 case (2.4%). Postoperative complications included: transient mild vitreous hemorrhage in 3 cases (7.1%), choroidal detachment in 1 case (2.4%), cystoid macular edema (CME) in 1 case (2.4%), optic capture in 1 case (2.4%), subconjunctival haptic in 2 cases (4.8%), ocular hypotony in 4 cases (9.5%) and ocular hypertension in 1 case (2.4%). There were no cases of retinal detachment or endophthalmitis. UBM showed optic tilt in 3 cases (30%).

Conclusion: Fixation of three-piece foldable IOL haptics in scleral tunnel parallel to the limbus-provided axial stability and proper centration of the IOL with minimal or no tilt in most cases and a low complication rate during the follow up period which lasted 6mo.

Keywords: aphakia correction; foldable three-piece intraocular lens; sutureless scleral fixation.

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Figures

Figure 1
Figure 1. Reference lines along the iris and the IOL optic axis were parallel.
Figure 2
Figure 2. Surgical technique
A: Introduction of IOL; B: Externalization of inferior haptic; C: Handshake technique; D: Externalization of both superior haptic; E: Introducing of the haptic in scleral tunnel; F: Closure of conjunctiva and stromal hydration of corneal wounds.
Figure 3
Figure 3. Comparison between preoperative and postoperative BCVA (logMAR).
Figure 4
Figure 4. Intra operative complications related to IOL haptic manipulation
A: Kinking of the inferior haptic during the pulling on it; B: Breakage of one haptic of the IOL, which necessitated replacement of the IOL.
Figure 5
Figure 5. Postoperative complications
A: Combined B&A scan US showing choroidal detachment complicating one case which resolved completely within 1wk with medical therapy; B: Optic capture and subconjunctival haptic evident by the red arrow; C: Subconjunctival haptic, shown by the red arrow in a case evident after 3wk from surgery.
Figure 6
Figure 6. Ultrasound biomicroscopy
A: No optic tilt (difference between distances of the two optic edges from posterior iris surface <0.1 mm); B: Optic tilt (difference between distances of the two optic edges from posterior iris surface >0.1 mm).
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