Real world outcomes of sutureless and glueless sclerally fixated intraocular lens implantation

Abstract

Purpose: To report the outcomes of sutureless intrascleral fixation of a 3-piece intraocular lens in the ciliary sulcus, in a large cohort of patients with aphakia of various aetiology METHODS: Retrospective, non-comparative, single centre interventional study of 250 aphakic eyes of various causes, which underwent sutureless and glueless intrascleral fixation of 3-piece intraocular lens (IOL). All patients were required to have at least 3 months of follow up post procedure to be included in the study. Anatomical and functional outcomes obtained were statistically analysed for significance.

Results: A total of 250 eyes of 246 patients were included in the study population. The average age was 56.5 years ± 16.4 (range 6-86 years). The mean best-corrected visual acuity (BCVA) significantly improved from 0.74 ± 0.6 logMAR (approx. Snellen equivalent 20/110) to 0.48 ± 0.36 logMAR (approx. Snellen equivalent 20/60), (p < 0.001) following surgery. Early postoperative complication (<2 weeks) included hypotony (n = 10, 4%), ocular hypertension (n = 38,15.2%) and vitreous haemorrhage (n = 50, 20%). Late complications included retinal detachment (n = 14, 5.6%%), cystoid macular oedema (n = 24, 9.6%), scleral erosion (n = 1, 0.4%), haptic extrusion to subconjunctival space (n = 3, 1.2%) and IOL subluxation or dislocation (n = 5, 2%) CONCLUSION: This cost-effective and easier technique of sutureless scleral fixated 3-piece IOL implantation provided good visual acuity outcomes in a large cohort of patients and was well tolerated.

Fig. 1. Key Instruments and surgical steps of sutureless scleral fixated IOL.

Main instruments for modified Gabor technique of Scleral fixated IOL; A Toric Marker, B 1.5 mm Keratome; Serial pictures elaborating the surgical steps of Scleral fixated IOL implantation, C Localized conjunctival peritomy at 9’0 clock, D Scleral incision being made with a Bard-Parker blade, E Lamellar scleral tunnel dissection with a 1.5 mm Keratome, F Introduction of a 24-gauge needle into the ciliary sulcus 1.5 mm behind the limbus, G Anterior chamber entry with a 3.2 mm keratome via the superior corneoscleral tunnel, H Introduction of a bent 26-gauge needle 1.5 mm behind limbus at 3’o clock and threading of 4 mm of the 3 piece IOL leading haptic into the lumen of the needle using a McPherson forceps and externalization, I Threading of the trailing 3 piece IOL haptic into the lumen of the 26-gauge needle and externalization, J Holding of the externalized haptic of the 3 piece IOL with a McPherson forceps, K Tucking of the 3 piece IOL haptic into the scleral tunnel with McPherson forceps, L Well centred IOL seen at end of surgery.

Fig. 2. (A) Box and Whisker plot showing comparison between preoperative and postoperative best-corrected visual acuity (BCVA) in different subgroups.

A Significant improvement in mean BCVA is seen in each subgroup, B Bar diagram elaborating the comparison between junior and senior surgeons with respect to various surgical complications. No significant difference was seen between both groups.