Recent advances and current challenges in suture and sutureless scleral fixation techniques for intraocular lens: a comprehensive review

Abstract

Over the past two decades, both suture and sutureless techniques for scleral fixation of intraocular lenses have seen significant advancement, driven by improvements in methodologies and instrumentation. Despite numerous reports demonstrating the effectiveness, safety, and superiority of these techniques, each approach carries with it its own drawbacks, including an elevated risk of certain postoperative complications. This article delves into various surgical techniques for scleral fixation of posterior chamber intraocular lenses, discussing their procedural nuances, benefits, drawbacks, postoperative complications, and outcomes. Furthermore, a comparative analysis between suture and sutureless fixation methods is presented, elucidating their respective limitations and associated factors. It is hoped that this comprehensive review will offer clinicians guidance on how to individualize procedural selection and mitigate surgical risks, and thus achieve optimal visual outcomes. This review will also endeavor to provide guidance for future advancements in intraocular lens fixation techniques.

Keywords: Aphakia; Intraocular lens implantation; Intrascleral fixation; Modified Yamane technique; Sutureless fixation; Transscleral suture fixation.

Fig. 1

Diagrammatic representations of suture flapless scleral fixation. a Six-point transscleral suture fixation by making three scleral pockets. (Reproduced with permission from Ref. [51]). b Intraocular suture looping technique. The 8–0 polypropylene suture was put into the guiding needle and then passed through the first fixation site of the sclera, the first eyelet of the IOL haptic, then the second eyelet of the homolateral IOL haptic. The IOL is fixed by fixation and anchor knots. (Reproduced with permission from Ref. [58]). c Modified sewing machine technique. Main surgical procedures: creation of suture loops on both sides of the IOL eyelets, adjusting the IOL centration, tying the free ends of the suture, and pushing knot into the tunnel. (Reproduced with permission from Ref. [63])

Fig. 2

Gabor’s technique and Agarwal’s glued IOL technique. a Gabor’s technique. Main surgical procedures: scleral tunnel preparation, externalization, and pulling the haptic into the limbus-parallel tunnel. (Reproduced with permission from Ref. [166]). b Agarwal’s glued IOL technique. Fibrin glue is applied, and the flap is sealed down over the haptic. (Reproduced with permission from Ref. [98])

Fig. 3

Diagrammatic representations of modified Yamane techniques. a Flattened flanged intrascleral fixation technique. The IOL haptic (dashed box) had a diameter of 170 μm; the diameter of the flange was 400 μm; the diameter of the flattened flange was 700 to 800 μm. b Modified Yamane technique with 26-gauge needles. (Reproduced with permission from Ref. [167]). c Operation of the forceps-needle device. d The double trimming of the haptics. The 2.0-mm section was cut off from the haptics before the IOL was inserted into the anterior chamber, and a 1.0-mm section was cut off the haptics after the implantation. (Reproduced with permission from Ref. [102]). e Four-flanged technique. Two flanges outside and two flanges in the eyelets of the IOL. (Reproduced with permission from Ref. [168]

Fig. 4

Intraoperative photos of modified Yamane techniques. a Creating the flange with a 532-nm Laser. (Reproduced with permission from Ref. [103]). b Creating the flange with the heated tip of a 26-gauge needle. (Reproduced with permission from Ref. [103])