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

Abstract

Background: To 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 design: Experimental study and case series.

Subjects: Optical bench test and eyes with IOL dislocation.

Methods: Two 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 (MTF_RMS), 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.

Results: The optical bench test showed no differences in MTF_RMS 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.

Conclusion: The 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.

Keywords: Flanged; Optic piercing; Scleral fixation.

Fig. 1

The preparation of the TECNIS Synergy IOL (Johnson & Johnson Vision) with optic piercing for the optical bench study using two separate 6 − 0 polypropylene monofilaments

Fig. 2

The four-flanged polypropylene optic piercing technique for scleral fixation of a one-piece multifocal intraocular lens (IOL) involves optic piercing using two separate 6–0 polypropylene sutures. After inserting the 30G needle into the peripheral optic of the IOL, the needle is withdrawn by docking a 6 − 0 polypropylene monofilament suture into the needle lumen so that the 6 − 0 polypropylene suture is pierced through the optic (a and b). The other end of the 6 − 0 polypropylene suture is then pierced through the adjacent peripheral optic of the IOL (c and d). Similarly, another 6–0 polypropylene monofilament suture is pierced twice into the opposing peripheral optic of the IOL (e). Four ends of the 6–0 polypropylene sutures are externalized to 2.5 mm posterior to the limbus using a 30G needle. Flanges are made at four ends of the 6–0 polypropylene monofilament sutures by heating with a cautery (f)

Fig. 3

Representative captured images of the 1951 United States Air Force resolution test chart using the TECNIS Synergy IOL with and without optic piercing using 6 − 0 polypropylene. The minus (–) diopter defocus represents near distance

Fig. 4

A comparison of the root mean square of modulation transfer function (MTF) values for a pupil size of 5.0 mm in the horizontal and vertical directions (MTF_RMS) between TECNIS Synergy IOLs with (piercing; solid line) and without (control; dotted line) optic piercing using 6 − 0 polypropylene sutures

Fig. 5

Preoperative anterior segment photograph (a), intraoperative photograph after surgery (b), and postoperative month one anterior segment photograph (c) of the right eye of case 1 using a PanOptix toric intraocular lens

Fig. 6

Preoperative anterior segment photographs (a and b), intraoperative photographs after surgery (c and d), and postoperative week three and four anterior segment photographs (e and f) of the right (a, c, and e) and left (b, d, and f) eyes of cases 2 and 3 using PanOptix and PanOptix toric intraocular lenses

Fig. 7

Intraocular lens (IOL) optic distortion caused by 6 − 0 polypropylene (a). In order to reduce distortion caused by the thickness of the 6 − 0 polypropylene (b), the area passing through the optic was flattened with forceps (c)