J Korean Ophthalmol Soc.  2012 Dec;53(12):1794-1800. 10.3341/jkos.2012.53.12.1794.

Modified Surgical Technique for Transscleral Fixation of a Single-Piece Acrylic Intraocular Lens in the Absence of Capsular Support

• Yang JY
• Chu YK

• KMID: 2216393
• DOI: http://doi.org/10.3341/jkos.2012.53.12.1794

Abstract

PURPOSE
To introduce a new surgical method of transscleral intraocular lens (IOL) fixation using a foldable, single-piece acrylic IOL with 4 loop haptics and to report the surgical results.
METHODS
After a single-piece acrylic IOL with 4 loop haptics was injected into the anterior chamber and positioned on top of the iris diaphragm, a 10-0 Prolene STC-6 straight needle and a 27-gauge needle were used to string the prolene thread through the haptic openings from front to back fixating the IOL to the sclera, resulting in a transscleral "1 loop 4 points" fixation. Twenty-eight eyes of 28 patients who had received transscleral fixation via this new technique were retrospectively reviewed. The best corrected vision acuity (BCVA) was measured after a postoperative period of at least 6 months. Intraoperative and postoperative complications were investigated.
RESULTS
In 27 out of 28 eyes (96.4%), the postoperative BCVA was better than 0.5 (Snellen chart). The only complication found was 1 case of choroidal detachment (3.6%).
CONCLUSIONS
The new transscleral "1 loop 4 points" fixation technique of a foldable, single-piece acrylic IOL in the absence of capsular support is an easy procedure and reduces surgical time and hastens visual rehabilitation due to excellent IOL positioning stability. Additionally, the technique described in the present study may be a safe procedure with minimal complications.

Keyword

Intraocular lens implantation; Scleral fixation

MeSH Terms

Anterior Chamber
Choroid
Diaphragm
Eye
Humans
Iris
Lens Implantation, Intraocular
Lenses, Intraocular
Needles
Operative Time
Polypropylenes
Postoperative Complications
Postoperative Period
Retrospective Studies
Sclera
Vision, Ocular
Polypropylenes

Figure

• 

  Figure 1 (A) The intraocular lens (IOL) is positioned on top of the iris diaphragm. The entry sites A,B,C, and D are marked 2.0 mm from the limbus and 6.0 mm from each other. (B) After using a hook to push one of the haptics behind the iris diaphragm, a double armed 10-0 prolene STC-6 straight needle is threaded through the haptic loop from front to back. (C) A 27-gauge needle is used to enter the sclera at site A and threaded through the haptic loop in the same manner as the prolene needle. (D, E) The prolene needle is docked within the 27 gauge needle and pulled out of the opposite sclera site A. (F-I) The second prolene needle is entered the sclera at site D and retrieved within the 27-gauge needle in the same manner as the first needle. (J) The sutures are tightened 3 times using a square knot. (K) The knot is rotated and buried into the scleral through site A.

• 

  Figure 2 (A) Immediate postoperative photograph shows the intraocular lens (IOL) was positioned correctly. The 2 black arrows indicate the prolene sutures which are located behind the IOL optic. (B) Postoperative photograph 1 year after undergoing '1 loop - 4 points' shows no definite tilting or decentering of the IOL. The 2 white arrows also indicate the prolene sutures.

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