Scleral fixation of hydrophobic acrylic intraocular lenses using a suture burial technique

The retrograde suture needle threading technique for in-situ repositioning of dislocated intraocular lenses with eyelets

BACKGROUND

Rescuing dislocated intraocular lenses (IOLs) with eyelets after scleral suture fixation presents technical challenges and risks of ocular tissue damage. We propose a novel in-situ rescue technique for repositioning dislocated IOLs with fixation eyelets. This approach avoids large incisions, accommodates dislocations in any direction, and offers a safer, more efficient alternative to traditional methods.

METHODS

The technique was performed on four patients with dislocated IOLs following scleral suture fixation. Under retrobulbar anesthesia, a retrograde suture-guided approach was employed. A double-armed polypropylene suture was introduced retrogradely into the eye via a puncture site. The suture arms were threaded through the fixation eyelet of the IOL haptic. One arm was then cut and hooked out through the eyelet. The broken ends of the two sutures were tied together. The IOL was adjusted to its proper position, and the suture was tightened to secure it to the sclera.

RESULTS

All four patients underwent successful in-situ IOL refixation without intraoperative complications. Postoperative examinations confirmed well-centered IOLs in all cases. Postoperative vision has significantly improved compared to preoperative vision. Over a follow-up period of 11-36 months, no redislocation or major complications were observed.

CONCLUSION

This in-situ rescue technique provides a safe, effective, and straightforward solution for fixing dislocated perforated IOLs. Its simplicity and positive outcomes position it as a promising option for managing these complex cases.

4-Point scleral fixation technique using Gore-tex® sutures for cut-out plated haptic intraocular lenses

Purpose

To report a 4-point scleral fixation technique utilizing Gore-tex® CV8 sutures and cut-out plated haptic intraocular lenses (IOLs) lacking a 4-eyelet haptic design for aphakic patients.

Observations

This scleral fixation technique utilizes Gore-tex CV8® sutures paired with a foldable, monofocal, cut-out plated haptic IOLs wherein the sutures are passed through the holes of the plate haptics. Initially, sectoral conjunctival peritomies are performed on the temporal and medial conjunctiva. This is followed by the creation of 4 sclerotomy sites 5mm from each other and 2mm from the limbus at the exposed medial and temporal sclera. A Gore-Tex® (CV8) suture is threaded under the plate haptic. The leading suture is then inserted intraocularly through the corneal incision and externalized through the inferior sclerotomy. The trailing end of the suture which is over the haptic plate is passed intraocularly and externalized through the same port. The externalized suture is brought back intraocularly through the superior sclerotomy and then re-externalized through the corneal incision. This suture end is then threaded through the superior portion of the plate haptic in an over-under fashion. The suture which has passed under the haptic plate, is then brought back intraocularly through the corneal incision and externalized through the superior sclerotomy creating a loop. The same steps are then performed on the contralateral side. The IOL is then inserted. Centration of the IOL is then achieved by adjusting the tension on the 4 externalized suture ends. The Gore-Tex® sutures are then tied and subsequently buried into the sclerotomy. Conjunctival peritomies are then repaired.

Conclusions and importance

Four-point fixation of cut-out plate haptic IOLs is achievable with predictable outcomes showing good centration, stability, visual and refractive outcomes providing surgeons additional options for fixation of available lenses as a secondary or primary implantation or by fixation of subluxed or dropped plate IOLs.

Sutured scleral fixation of existing subluxated/dislocated acrylic one-piece intraocular lenses

AIM

To evaluate the visual and refractive outcomes in cases after sutured scleral fixation of existing subluxated or dislocated acrylic one-piece intraocular lenses (IOLs).

METHODS

This study retrospectively enrolled a consecutive series of patients who underwent a surgery of sutured existing subluxated or dislocated IOLs from October 2018 to June 2020. All patients underwent comprehensive preoperative and postoperative ophthalmologic examination, and data were collected including age, sex, surgical indications, best-corrected visual acuity, refractive error, intraocular pressure. Presence of intraoperative and postoperative surgical complications was documented.

RESULTS

A total of 20 consecutive cases were enrolled for analysis with mean final follow-up period 9.8±5.3mo. Visual acuity improved from a mean of 0.35 (0.46±0.32 logMAR) preoperatively to 0.61 (0.21±0.18 logMAR) at the 3-month follow-up (P=0.002). The mean amount of preoperative keratometric astigmatism and total postoperative refractive astigmatism was -1.24±0.80 diopters (D) and -1.42±0.97 D, respectively. There was no statistically significant difference between preoperative and postoperative astigmatism (P=0.156). The mean IOL-induced astigmatism was -0.23±0.53 D. The mean spherical equivalent at the 3-month follow-up was -0.1±0.94 D. No major complications were noted during the follow-up period.

CONCLUSION

Surgical techniques using sutured scleral fixation of existing subluxated or dislocated acrylic one-piece IOLs result in favorable visual and refractive outcomes without major complications.

Application of the suture needle retrograde threading method in scleral fixation of intraocular lenses

BACKGROUND

Here we described a new threading technique for the universal fixation of any posterior chamber intraocular lens (IOL).

METHODS

Twenty-seven eyes of 27 patients whose surgery done by Surgeon A with the needle-guided method or the suture needle retrograde threading (SNRT) method for intrascleral IOL fixation were enrolled in the first group. Thirty-four eyes of 34 patients whose surgery done by Surgeon A, Surgeon B or Surgeon C with the SNRT method for intrascleral IOL fixation were grouped into three sub-groups by surgeon. Information regarding age, sex, best-available visual acuity (BCVA), intraocular pressure (IOP), past ophthalmological history, threading time (from puncturing to externalizing suture) and complications during and after the surgery were gathered.

RESULTS

The analysis showed that the threading time was less in the SNRT group than needle-guided group by Surgeon A. There was one eye with suture needle slipping from the guide needle when guiding out of the eye. The threading procedure was completed one time without suture ruptures or loop slippage in the SNRT group operated by Surgeon A. And using the SNRT method, Surgeon A, Surgeon B, and Surgeon C did not show any significant difference in threading time. No complications (e.g., vitreous hemorrhage, hyphemia, retinal detachment, suprachoroidal hemorrhage, or hypotony) were observed during surgery or postoperatively in all cases. No leakage occurred at the site of the puncture after the operation.

CONCLUSIONS

The described technique appears to be a safe, simple, easy-to-learn, and universal surgical method, which is suitable for various types of IOLs.