Modified Cow-Hitch Suture for Repositioning of Subluxated Scleral-Fixated Rigid Intraocular Lens

Novel Technique for 27-Gauge Forceps-Assisted Transscleral Refixation of the Dislocated CZ70BD Intraocular Lens

PURPOSE

To report a novel technique for refixation of the dislocated CZ70BD intraocular lens.

METHODS

Posterior vitrectomy is performed with a 23-gauge or 25-gauge pars plana vitrectomy system with chandelier illumination. One needle of a double-arm 9-0 prolene needle is passed through the sclera 1.5 mm postlimbus. The needle is retrieved through the corneal paracentesis using a 27-G needle, and the suture is then cut. The suture end is passed through the eyelet of the dislocated CZ70BD intraocular lens inside the vitreous cavity. This is aided with a pair of 27-G MaxGrip forceps, which is inserted through a 27-G sclerostomy site at the intended scleral outlet. After passing the suture through the eyelet, the suture is pulled out at the 27-G sclerostomy site and a knot is tied and rotated. Similar procedure is performed for the second haptic if necessary.

RESULTS

Seven eyes were successfully operated on using this technique with a mean follow-up of 12.4 months. There was significant improvement in the best-corrected visual acuity after the operation ( P = 0.016). Postoperative intraocular lens centration and alignment were satisfactory. One patient developed macula-on retinal detachment 1 month after the operation, which was successfully repaired without loss in the best-corrected visual acuity.

CONCLUSION

The described novel technique is effective for refixation of dislocated CZ70BD intraocular lens.

Short-term outcomes of a modified technique for small-incision scleral-fixated intraocular lens implantation using Gore-Tex sutures

PURPOSE

To report the short-term outcomes of a modified small-incision technique for implantation of scleral-fixated intraocular lenses (IOLs) using Gore-Tex sutures.

METHODS

A retrospective, interventional, consecutive case series was conducted. From June 2019 to February 2020, 10 patients underwent small-incision scleral-fixated IOL implantation using Gore-Tex sutures at a tertiary referral center. Visual and anatomical outcomes and complications were recorded with a minimum follow-up period of 3 months. Surgically induced astigmatism (SIA) and IOL-induced astigmatism were measured.

RESULTS

The mean follow-up duration (range) was 396 (240-573) days. Best-corrected visual acuity improved significantly from logarithm of the minimal angle of resolution (logMAR) 0.88 ± 0.65 (Snellen equivalent: 20/153) preoperation to logMAR = 0.30 ± 0.51 (Snellen equivalent: 20/40) at final follow-up (P = .008). The estimated SIA and IOL-induced astigmatism were 0.61 diopters (D) ± 0.49D and 0.40D ± 0.36D, respectively. No intraoperative complications occurred. The postoperative complications, which included ocular hypertension (20%), cystoid macular edema (30%), and vitreous hemorrhage (20%), were transient and resolved with topical medication.

CONCLUSIONS

The modified small-incision technique for implantation of scleral-fixated IOLs using Gore-Tex sutures was well tolerated in all patients, with favorable postoperative visual outcomes and minimal SIA and IOL-induced astigmatism.