Modified Four-Point Scleral Suture Fixation Technique for Repositioning a Dislocated Intraocular Lens in the Absence of Capsule Support

Purpose. To study the efficacy of a modified four-point fixation technique for the repositioning of a dislocated intraocular lens (IOL) with four eyelets in the absence of capsule support. Methods. Four patients with dislocated four-eyelet hydrophilic acrylic IOLs (Akreos AO60) were enrolled. The modified technique combined four-point fixation with intrascleral sutures and suture burying. The technique minimized the limbus incision to 1 mm with no externalization of the IOL or its haptics. Follow-ups included routine ophthalmic examinations, corneal endothelial cell counts, and measurement of IOL tilt and decentration (measured using Pentacam® HR images). Results. The IOLs were successfully repositioned in all cases. After a mean follow-up period of 19.75 ± 7.85 months (range: 8 to 24 months), the patients’ best-corrected vision acuity (BCVA (LogMAR), before: 0.63 ± 0.36, after: 0.58 ± 0.43, P = 0.604 ) and intraocular pressure (pre 13.35 ± 0.85 mmHg, post 14.80 ± 2.03 mmHg, P = 0.150 ) remained unchanged. Corneal endothelium density decreased about 6.84 ± 2.97%. In all cases, the IOL was well positioned during the follow-up. At the final visit, the average IOL tilt was 1.36 ± 0.35° horizontally and 1.31 ± 0.14° vertically. The average IOL decentration was 0.23 ± 0.12 mm horizontally and 0.18 ± 0.13 mm vertically. Conclusions. With this modified technique, dislocated IOLs with four-eyelets could be treated safely with favorable outcomes.

Traumatic globe rupture after non-Descemet’s stripping automated endothelial keratoplasty with scleral suture fixation of intraocular lens: a case report

Background: To report the first case of traumatic globe rupture after non-Descemet stripping automated endothelial keratoplasty (nDSAEK) with scleral suture fixation of intraocular lens (IOL). Case presentation: A 71-year old male was referred to our hospital with reduced vision in his left eye. He underwent cataract surgery in his left eye about 10 years ago. At presentation, slit-lamp examination of his left eye showed aphakic bullous keratopathy. We performed nDSAEK with scleral suture fixation of IOL. The surgical outcome was favorable. At 5 years after nDSAEK, he sustained globe rupture in his left eye from a fall. Slit-lamp examination demonstrated wound dehiscence and iris prolapse beneath the conjunctiva. However, the transplanted endothelium and Descemet’s membrane was attached completely to the recipient cornea, and there was no dislocation of the implanted IOL. No abnormal findings were observed in the posterior segment. We performed wound suturing and iris reconstruction. After 45 months, recipient and donor cornea retained clarity, and his visual acuity was 20/25. Conclusions: We encountered a patient with traumatic globe rupture after nDSAEK. It can be presumed that traumatic wound dehiscence after DSAEK is better visual outcome than traumatic wound dehiscence after conventional PKP. DSAEK might be resistant to traumatic injury because of the minimal incision than PKP. Key words: Descemet’s stripping automated endothelial keratoplasty, traumatic globe rupture, corneal transplantation

Suturing technique for scleral fixation of toric intraocular lens in the traumatic aphakic eye with corneal astigmatism

Purpose: To describe the clinical outcomes of traumatic aphakic eyes with corneal astigmatism after using a novel technique for toric intraocular lens suture fixation. Methods: In total, 12 eyes of 12 patients who underwent a new scleral suture fixation technique of one-piece toric intraocular lens (SN6AT series, Alcon Inc., TX, USA) were included in our retrospective study. Preoperative patient status, postoperative visual acuity and refractive outcomes, postoperative intraocular lens rotation, tilt, decentration, and complications were analyzed. Results: The mean follow-up was 11.6 ± 1.0 months. The mean preoperative best-corrected visual acuity was 0.55 ± 0.32 in the logarithm of minimum angle of resolution equivalent; the postoperative best-corrected visual acuity was 0.45 ± 0.34. The mean preoperative total corneal astigmatism was 2.51 ± 1.67 D. The mean postoperative residual astigmatism was 0.77 ± 0.54 D. The mean intraocular lens rotation was 3.33° ± 1.37° (range, 1°–6°). The mean intraocular lens tilt in horizontal direction was 3.64° ± 1.02° (range, 2.6°–6.3°) and in vertical direction it was 3.19° ± 1.07 ° (range, 1.6°–5.2°). The mean intraocular lens decentration in horizontal direction was 0.14 ± 0.03 mm (range, 0.089–0.192 mm) and in vertical direction it was 0.15 ± 0.02 mm (range, 0.113–0.181 mm). One patient had mild vitreous hemorrhage and two other patients had high postoperative residual sphere and astigmatism, respectively. But no other serious complications were observed. Conclusion: Scleral suture fixation of foldable toric intraocular lens to correct corneal astigmatism can be a safe and effective alternative technique to manage traumatic aphakic eyes that lack adequate capsular support.