J Korean Ophthalmol Soc.  2019 Mar;60(3):246-252. 10.3341/jkos.2019.60.3.246.

Short-term Clinical Outcomes of Scleral Fixation of Intraocular Lenses Using a Scleral Tunnel and Groove

• Moon TK
• Jang JY
• Jung HH
• Ji YS

• KMID: 2440452
• DOI: http://doi.org/10.3341/jkos.2019.60.3.246

Abstract

PURPOSE
We evaluated the short-term clinical outcomes of patients who underwent modified scleral fixation of an intraocular lens (IOL) using a scleral tunnel and groove.
METHODS
From June 2016 to May 2017, 34 eyes of 34 patients who underwent modified scleral fixation of an IOL using a scleral tunnel and groove were retrospectively studied. We evaluated the best-corrected visual acuity (BCVA), corneal endothelial cell density, intraocular pressure (IOP), spherical equivalent, and postoperative complications at 1 week, 1 month, 3 months, and 6 months after surgery.
RESULTS
The BCVA was 0.85 ± 0.83 logarithm of the minimal angle of resolution (logMAR) before surgery and 0.38 ± 0.61 logMAR at 6 months (p = 0.001). The corneal endothelial cell count was 1,955.12 ± 217/mm2 and 1,852.59 ± 190/mm2, before and after surgery, respectively, which was not significantly different (p = 0.186). Postoperative complications occurred in eight eyes (23.5%); IOP elevation in one eye (2.9%), IOL tilt or decentration in two eyes (5.7%), optic capture in four eyes (11.4%), and cystic macular edema in one eye (2.9%). The spherical equivalent showed myopic changes after surgery and decreased significantly over time (p = 0.001).
CONCLUSIONS
Modified scleral fixation of the IOL using a scleral tunnel and groove improved the BCVA, but did not significantly affect corneal endothelial cell loss. This procedure can be a good alternative to conventional scleral fixation of an IOL, which has advantages in shortened surgical time and easy surgical manipulation.

Keyword

Intraocular lens; Scleral fixation; Scleral tunnel and groove

MeSH Terms

Corneal Endothelial Cell Loss
Endothelial Cells
Humans
Intraocular Pressure
Lenses, Intraocular*
Macular Edema
Operative Time
Postoperative Complications
Retrospective Studies
Visual Acuity

Figure

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  Figure 1. The surgical procedure of scleral fixation of intraocular lens (IOL) through scleral tunnel and groove. (A) The 8-lines corneal marker is used to mark 1 and 7 o'clock directions from corneal center. (B) Six points on sclera are marked at 1.5 mm posterior to the limbus (point 1: at 7 o'clock direction, point 2: at 1.0 mm away from point 1 counterclockwise, point 3: 3.0 mm away from point 2 counterclockwise, point 4: at 1 o'clock direction, point 5: at 1.0 mm away from point 4 counterclockwise, point 6: 3.0 mm away from point 5 counterclockwise). (C) Two limbal parallel scleral tunnels (3.0 mm length, 1/2 scleral thickness) are made using a 23-gauge needle (one: line between point 2 and 3, the other: line between point 5 and 6). (D) Two scleral grooves 1.0 mm long are made using a stab knife (one: line between point 1 and 2, the other: line between point 4 and 5). (E) Two full-thickness scleral incisions are made using a stab knife above point 1 and 4. (F) The leading haptic is held and then pulled out of the eye through the scleral incisions using 23-gauge microforceps. (G) The both haptics are inserted into the scleral tunnel. Then, the IOL is placed into position. (H) The conjunctiva is closed with 8–0 vicryl.

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  Figure 2. Complications of scleral fixation of intraocular lens (IOL) through sclera tunnel and groove. (A, B) Optic capture. (C) Cystoid macular edema. (D) IOL decentration.

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  Figure 3 Post-operative anterior segment optical coherence tomography (OCT). (A) A typical OCT image in the patient at 3 months after surgery. (B) OCT shows the scleral tunnel with the incarcerated haptic of the intraocular lens at 3 months. There are no signs of leakage or inflammation.

Reference

References

1. Engren AL, Behndig A. Anterior chamber depth, intraocular lens position, and refractive outcomes after cataract surgery. J Cataract Refract Surg. 2013; 39:572–7.

2. Sasaki K, Sakamoto Y, Shibata T, et al. Measurement of abdominal intraocular lens tilting and decentration using Scheimpflug images. J Cataract Refract Surg. 1989; 15:454–7.

3. Lee Y, Kim MH, Park YL, et al. Comparison of short-term clinical outcomes between scleral fixation vs. iris fixation of dislocated IOL. J Korean Ophthalmol Soc. 2017; 58:1131–7.

4. Oh SY, Kim SS. Astigmatic changes and clinical outcomes after scleral fixation of IOL. J Korean Ophthalmol Soc. 2014; 55:1452–9.

5. Lewis JS. Ab externo sulcus fixation. Ophthalmic Surg. 1991; 22:692–5.

6. Scharioth GB, Prasad S, Georgalas I, et al. Intermediate results of sutureless intrascleral posterior chamber intraocular lens fixation. J Cataract Refract Surg. 2010; 36:254–9.

7. Agarwal A, Kumar DA, Jacob S, et al. Fibrin glue–assisted abdominal posterior chamber intraocular lens implantation in eyes with deficient posterior capsules. J Cataract Refract Surg. 2008; 34:1433–8.

8. Yamane S, Inoue M, Arakawa A, Kadonosono K. Sutureless 27-gauge needle guided intrascleral intraocular lens implantation with lamellar scleral dissection. Ophthalmology. 2014; 121:61–6.

9. Gabor SG, Pavlidis MM. Sutureless intrascleral posterior chamber intraocular lens fixation. J Cataract Refract Surg. 2007; 33:1851–4.

10. Rodríguez-Agirretxe I, Acera-Osa A, Ubeda-Erviti M. Needleguided intrascleral fixation of posterior chamber intraocular lens for aphakia correction. J Cataract Refract Surg. 2009; 35:2051–3.

11. Verbruggen KH, Rozema JJ, Gobin L, et al. Intraocular lens centration and visual outcomes after bag-in-the-lens implantation. J Cataract Refract Surg. 2007; 33:1267–72.

12. Zeh WG, Price FW Jr. Iris fixation of posterior chamber intraocular lenses. J Cataract Refract Surg. 2000; 26:1028–34.

13. Por YM, Lavin MJ. Techniques of intraocular lens suspension in the absence of capsular/zonular support. Surv Ophthalmol. 2005; 50:429–62.

14. Azar DT, Wiley WF. Double-knot transscleral suture fixation abdominal for displaced intraocular lenses. Am J Ophthalmol. 1999; 128:644–6.

15. Bloom SM, Wyszynski RE, Brucker AJ. Scleral fixation suture for dislocated posterior chamber intraocular lens. Ophthalmic Surg. 1990; 21:851–4.

16. Chan CK. An improved technique for management of dislocated posterior chamber implants. Ophthalmology. 1992; 99:51–7.

17. McAllister AS, Hirst LW. Visual outcomes and complications of scleral fixated posterior chamber intraocular lenses. J Cataract Refract Surg. 2011; 37:1263–9.

18. Ohta T, Toshida H, Murakami A. Simplified and safe method of abdominalless intrascleral posterior chamber intraocular lens fixation: Y-fixation technique. J Cataract Refract Surg. 2014; 40:2–7.

19. Wilgucki JD, Wheatley HM, Feiner L, et al. One-year outcomes of eyes treated with a sutureless scleral fixation technique for abdominal lens placement or rescue. Retina. 2015; 35:1036–40.

20. Zhang Y, He F, Jiang J, et al. Modified technique for intrascleral fixation of posterior chamber intraocular lens without scleral flaps. J Cataract Refract Surg. 2017; 43:162–6.