Review of Surgical Techniques for Posterior Chamber Intraocular Lens Fixation in the Absence of Capsular Lens Support

This is a review of surgical options for posterior chamber intraocular lens (IOL) fixation in the absence of adequate capsular support. The indications, techniques, and outcomes for posterior chamber iris-sutured and scleral-fixated IOLs, including trans-scleral sutured and trans-scleral tunnel glued fixation, are reviewed. Iris-sutured IOL fixation may be appropriate in cases in which small corneal incisions with a foldable IOL are desired, but are only possible in cases of adequate iris tissue, and may be complicated by pupil ovaling and iris trauma, which can lead to prolonged inflammation in some studies. Scleral-sutured IOL fixation does not require robust iris tissue and decreases the risk for iris trauma, but is technically more demanding, may require larger incisions, and poses potentially more posterior segment complications. There are also ongoing concerns for suture exposure, erosion, and late suture breakage and IOL dislocation. Scleral tunnel-glued IOL fixation is a more recent innovation that avoids sutures and concerns for suture-related complications, and can be completed through smaller incisions with a foldable IOL. However, long-term studies are pending.

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Novel Technique to Overcome the Nonavailability of a Long Needle 9-0 Polypropylene Suture for Sutured Scleral Fixation of the Posterior Chamber Intraocular Lens Using a Single Fisherman’s Knot

Journal of Ophthalmology ◽

10.1155/2017/2683415 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Yong Un Shin ◽

Mincheol Seong ◽

Hee Yoon Cho ◽

Min Ho Kang

Keyword(s):

Intraocular Lens ◽

Posterior Chamber ◽

Intraoperative Complication ◽

Scleral Fixation ◽

Polypropylene Suture ◽

Endothelial Cell Count ◽

Intraocular Hemorrhage ◽

Posterior Chamber Intraocular Lens ◽

Iol Dislocation

Purpose. To describe a method to overcome the nonavailability of a long needle 9-0 polypropylene suture for sutured scleral fixation of the posterior chamber intraocular lens (PC-IOL) using a single fisherman’s knot (SFK). Methods. First, a 10-0 polypropylene suture was passed from the sclera to the ciliary sulcus using a long needle. A 9-0 suture was tied to the unpassed portion of the 10-0 suture with an SFK. We pulled the 10-0 suture to pass the SFK through the sclera, and then we cut the knot and removed the 10-0 suture. IOL fixation with 9-0 sutures used the conventional techniques used for sutured scleral-fixated IOL. Preoperative and postoperative visual acuity, corneal astigmatism, and endothelial cell count and intraoperative/postoperative complications were evaluated. Results. An SFK joining the two sutures was passed through the sclera without breakage or slippage. A total of 35 eyes from 35 patients who underwent sutured scleral fixation of the IOL. An intraoperative complication (minor intraocular hemorrhage) was recorded in four cases. Knot exposure, IOL dislocation, subluxation, and retinal detachment were not observed. Conclusions. The SFK offers the opportunity to use 9-0 sutures for the long-term safety and may not require the surgeon to learn any new technique.

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Long-Term Outcome of Combined Pars Plana Vitrectomy and Scleral Fixated Sutured Posterior Chamber Intraocular Lens Implantation

American Journal of Ophthalmology ◽

10.1016/j.ajo.2005.09.012 ◽

2006 ◽

Vol 141 (2) ◽

pp. 308-312.e1 ◽

Cited By ~ 136

Author(s):

Brendan J. Vote ◽

Paris Tranos ◽

Catey Bunce ◽

David G. Charteris ◽

Lyndon Da Cruz

Keyword(s):

Intraocular Lens ◽

Pars Plana Vitrectomy ◽

Posterior Chamber ◽

Intraocular Lens Implantation ◽

Term Outcome ◽

Long Term Outcome ◽

Posterior Chamber Intraocular Lens ◽

Lens Implantation ◽

Pars Plana

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Long-Term Stability of Sutured Scleral Fixation of a Posterior Chamber Intraocular Lens With 10-0 Polypropylene for More Than 30 Years

Journal of VitreoRetinal Diseases ◽

10.1177/2474126420978870 ◽

2021 ◽

pp. 247412642097887

Author(s):

Gregg T. Kokame ◽

Tarin T. Tanji ◽

Jase N. Omizo

Keyword(s):

Intraocular Lens ◽

Posterior Chamber ◽

Scleral Flap ◽

Scleral Fixation ◽

Polypropylene Suture ◽

Long Term Stability ◽

Posterior Chamber Intraocular Lens ◽

Polypropylene Sutures

Purpose: We report the longest follow-up to our knowledge of stable scleral fixation of a posterior chamber intraocular lens (PC IOL) with 10-0 polypropylene sutures. Methods: A retrospective review is presented of a case with more than 30 years’ follow-up after performing sutured scleral fixation with 10-0 polypropylene suture using 2 sutures tied together under a scleral flap. One suture was a cow-hitch looped around the haptic, and the other suture was passed through the sclera to create the scleral fixation. Results: The scleral fixation with 10-0 polypropylene suture knots for both haptics of the PC IOL allowed central optic positioning with excellent vision for more than 30 years without suture breakage. Conclusions: Polypropylene sutures for scleral fixation of PC IOLs remained stable for more than 30 years with central positioning of the PC IOL, without exposure of the fixation suture knots through the conjunctiva, and without suture breakage.

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Pupil dynamics after in-the-bag versus anterior and retropupillary iris-fixated intraocular lens implantation

Scientific Reports ◽

10.1038/s41598-021-01051-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yanxiu Sun ◽

Maximilian Hammer ◽

Timur M. Yildirim ◽

Ramin Khoramnia ◽

Gerd U. Auffarth

Keyword(s):

Intraocular Lens ◽

Pupil Size ◽

Surgical Techniques ◽

Case Series ◽

Case Series Study ◽

Pupil Motility ◽

Series Study ◽

Iol Fixation ◽

Iol Dislocation ◽

Iris Claw

AbstractAn Intraocular Lens (IOL) fixated on the iris either anteriorly, as a phakic IOL, or posteriorly, as an aphakic IOL, can influence pupil motility. In this interventional case series study, we evaluated pupil size under different levels of illumination (scotopic = 0.04 lx, low-mesopic = 0.4 lx and high-mesopic = 4 lx) for anterior iris-claw IOL fixation for correcting myopia or hyperopia (IFPH), retropupillary iris-claw IOL fixation to correct aphakia or as treatment for late in-the-bag IOL dislocation/subluxation (IFRP), and capsular-fixation IOL in-the-bag implantation (IB). Pupil size was measured preoperatively for the IFPH- and IB-group as well as 6 months after surgery for all groups. We analyzed a total of 70 eyes: 22 eyes of 11 patients with phakic IOLs, 22 eyes of 20 patients in the IFRP group and 26 eyes of 13 patients in the IB group. Both IFPH and IB showed a smaller postoperative scotopic pupil size, compared with the preoperative values. When compared to postoperative values of IB and IFPH, IFRP showed a significantly smaller postoperative scotopic pupil size (IFPH: 5.89 ± 0.83 mm, IFRP: 4.37 ± 0.83 mm, IB: 5.34 ± 0.98 mm, p < 0.001) while no differences were seen at high-mesopic lighting. Neither of the surgical techniques seems to impair the constriction of the pupil.

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Evaluation of Sutureless, Glueless, Flapless, Intrascleral Fixated Posterior Chamber Intraocular Lens in Children with Ectopia Lentis

Journal of Ophthalmology ◽

10.1155/2018/3212740 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Kannan NB ◽

Piyush Kohli ◽

Bhanu Pratap Singh Pangtey ◽

Kim Ramasamy

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Pediatric Population ◽

Intraoperative Complications ◽

Vitreous Hemorrhage ◽

Posterior Chamber ◽

Ectopia Lentis ◽

Uncorrected Visual Acuity ◽

Posterior Chamber Intraocular Lens

Aim. This paper aims at evaluating refractive outcome and complication profile of sutureless, glueless, flapless, intrascleral fixation of intraocular lens (SFIOL) in pediatric population. Methods. This retrospective study included patients ≤18 years of age who underwent SFIOL for ectopia lentis. Details obtained included preoperative uncorrected visual acuity (UCVA), cycloplegic refraction, and best-corrected visual acuity (BCVA); intraoperative complications; and postoperative UCVA, cycloplegic refraction, and BCVA and complications. Results. Median pre- and postoperative UCVA was logMAR 1.78 (Snellen 20/1200) and logMAR 0.30 (Snellen 20/40), respectively, (p<0.001). Median pre- and postoperative BCVA was logMAR 0.24 (Snellen 20/34) and logMAR 0.18 (Snellen 20/30), respectively. UCVA ≥20/60 was attained in 90% of eyes. BCVA ≥20/30 was attained in 85.0% of eyes. Most common early postoperative complications were hyphaema (10%), transient vitreous hemorrhage (2.5%), and ocular hypotony (2.5%). None of these developed any long-term sequelae. Only one case of subluxation of IOL was seen. No case of late endophthalmitis or retinal detachment was seen. Conclusion. Since refractive error induced is minimal, the procedure is suitable for IOL implantation in children, who are noncompliant with spectacles. The complication profile is similar to that reported in adults.

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