Korean J Ophthalmol.  2014 Apr;28(2):181-185. 10.3341/kjo.2014.28.2.181.

Sutureless Intrascleral Pocket Technique of Transscleral Fixation of Intraocular Lens in Previous Vitrectomized Eyes

• Cho YW
• Chung IY
• Yoo JM
• Kim SJ

• KMID: 1792114
• DOI: http://doi.org/10.3341/kjo.2014.28.2.181

Abstract

In this case series, we assessed a new technique, the intrascleral pocket procedure of transscleral fixation (TF) of the intraocular lens (IOL) in post-vitrectomized eyes. We performed the transscleral fixation of IOL in four aphakic patients who underwent pars plana vitrectomy. Two points 180degrees apart were marked at the limbus. A 2-mm-sized intrascleral pocket was created by lamellar dissection using a crescent blade without conjunctival dissection. A 2.8-mm clear corneal incision (CCI) was made using a keratome. Prolene sutures were exteriorized through the CCI pocket and a three-piece foldable acrylic IOL was injected via CCI and the ends of the haptics were exteriorized through the CCI. The prolene sutures for each haptic in the intrascleral pocket bed were then tied and knots were buried under scleral flaps. No patient had complaints such as conjunctival irritation, and visual acuity was almost identical to preoperative best-corrected visual acuity at day 1 postoperatively. IOLs were well placed without tilting or subluxation. They had no wound dehiscence or endophthalmitis postoperatively. The intrascleral pocket procedure of TF without the need for conjunctival dissection is a successful method for sulcus fixation in post-vitrectomized eyes predisposed to developing glaucoma.

Keyword

Aphakia; Intraocular lens implantation; Intrascleral pocket; Transscleral fixation

MeSH Terms

Aged
Aged, 80 and over
Aphakia/*surgery
Female
Humans
Lens Implantation, Intraocular/*methods
*Lenses, Intraocular
Male
Middle Aged
Sclera/*surgery
Sutures
Treatment Outcome
*Vitrectomy

Figure

• 

  Fig. 1 Sutureless intrascleral pocket technique for transscleral fixation of intraocular lens (IOL). Two points 180° apart marked at the limbus (A) and intrascleral pocket were created by lamellar dissection using a crescent blade without conjunctival dissection (B,C). Transscleral passage of a straight needle with a 10-0 polypropylene suture was performed 1.5 mm behind the limbus (D). A 2.8-mm clear corneal incision (CCI) made in the anterior limbus using a keratome. Prolene sutures exteriorized through the CCI pocket with a hook and a three-piece foldable acrylic IOL were injected with the injector system via CCI and the ends of the haptics were exteriorized through the CCI, and then prolene sutures for each haptic were tied (E). After achieving proper centration of IOL, ends of prolene were sutured at the intrascleral pocket bed (F,G). Knots were buried under scleral flaps to prevent exposure and trued up the edges of the conjunctiva to be joined without suture (H,I).

• 

  Fig. 2 Slit-lamp photography (A) and anterior segment optical coherence tomography (B) day 1 after transscleral fixation of intraocular lens using the intrascleral pocket technique showed that conjunctival and scleral alignment was maintained without a notable wound gap.

Reference

1. Wagoner MD, Cox TA, Ariyasu RG, et al. Intraocular lens implantation in the absence of capsular support: a report by the American Academy of Ophthalmology. Ophthalmology. 2003; 110:840–859.

2. Lewis JS. Ab externo sulcus fixation. Ophthalmic Surg. 1991; 22:692–695.

3. Teichmann KD. Pars plana fixation of posterior chamber intraocular lenses. Ophthalmic Surg. 1994; 25:549–553.

4. Kim DH, Heo JW, Hwang SW, et al. Modified transscleral fixation using combined temporary haptic externalization and injector intraocular lens implantation. J Cataract Refract Surg. 2010; 36:707–711.

5. Ma DJ, Kim MK, Wee WR. Knotless external fixation technique for posterior chamber intraocular lens transscleral fixation: a 5-case analysis. J Korean Ophthalmol Soc. 2012; 53:1609–1614.

6. Lin CP, Tseng HY. Suture fixation technique for posterior chamber intraocular lenses. J Cataract Refract Surg. 2004; 30:1401–1404.

7. Solomon K, Gussler JR, Gussler C, Van Meter WS. Incidence and management of complications of transsclerally sutured posterior chamber lenses. J Cataract Refract Surg. 1993; 19:488–493.

8. Lewis JS. Sulcus fixation without flaps. Ophthalmology. 1993; 100:1346–1350.

9. Kir E, Kocaturk T, Dayanir V, et al. Prevention of suture exposure in transscleral intraocular lens fixation: an original technique. Can J Ophthalmol. 2008; 43:707–711.

10. Malbran ES, Malbran E Jr, Negri I. Lens guide suture for transport and fixation in secondary IOL implantation after intracapsular extraction. Int Ophthalmol. 1986; 9:151–160.

11. Szurman P, Petermeier K, Aisenbrey S, et al. Z-suture: a new knotless technique for transscleral suture fixation of intraocular implants. Br J Ophthalmol. 2010; 94:167–169.

12. Stewart MW, Landers MB 3rd. Transscleral intraocular lens fixation with a "homemade" needle and hook. J Cataract Refract Surg. 2006; 32:200–202.

13. Joo J, Lee YK, Rho CR, et al. Transscleral fixation of intraocular lens using the triple cow-hitch method. J Korean Ophthalmol Soc. 2011; 52:1370–1376.

14. Mannan R, Sinha R, Sharma N, et al. Intrascleral reverse pocket approach of transconjunctival transscleral sulcus fixation of intraocular lens in eyes with ocular trauma. Eye Contact Lens. 2011; 37:316–319.