Iridodialysis Repair With Intrascleral Fixation of Flattened Flanged Polypropylene Suture

Intrascleral fixation of capsular bag and intraocular lens in cases with large zonular dialysis

PURPOSE

To evaluate the clinical outcomes of sutureless capsular bag and intraocular lens (IOL) fixation with flattened, flanged intrascleral fixation technique in patients with large zonular dialysis.

METHODS

Fifty-five eyes of 51 patients who underwent flattened flanged intrascleral capsular bag and IOL fixation and optic capture for traumatic cataract, subluxated cataract, and pseudoexfoliation syndrome (PEX) with zonular dialysis greater than 180° were included in the study. The main difference of this technique from the Yamane technique is that it has a flattened flange with sharp borders at the haptic tip. Uncorrected visual acuity, corrected distance visual acuity (CDVA), astigmatism, endothelial cell loss, IOL tilt, and intraoperative and postoperative complications were evaluated.

RESULTS

The mean age of the patients was 57.4 ± 15.1 years (range 18-83). Of the patients, 28 (55%) were male and 23 (45%) were female. The mean duration of follow-up after surgery was 19.3 ± 6.5 months (range 12-36). The mean preoperative and postoperative CDVA were 0.71 ± 0.16 logMAR and 0.13 ± 0.20 logMAR, respectively (p < 0.001). The mean preoperative and postoperative astigmatism were 2.0 ± 1.4 D and 1.0 ± 0.7 D, respectively (p < 0.001). The mean IOL tilt was 5.7° ± 5.2°. The mean endothelial cell loss was 9% (range 0.9-19.5). Anterior capsular phimosis was developed in 2 eyes (4%).

CONCLUSION

The flattened flanged intrascleral technique of the capsular bag combined with optic capture provides good visual outcomes, robust capsular bag-IOL fixation, and minimal adverse events. However, further studies with more patients are needed for long-term results.

Facilitated trailing haptic externalization technique for intrascleral intraocular lens fixation

PURPOSE

To describe the facilitated trailing haptic externalization technique for intrascleral intraocular lens (IOL) fixation.

METHODS

In this technique, first the direction of the 4-5 mm tip of the trailing haptic is straightened with the help of forceps. After the second needle enters the posterior chamber, the edge of the IOL optic is pushed towards the opposite scleral tunnel with the needle. The trailing haptic approaching the center from the periphery and the straightened distal part of the haptic towards the direction of the needle facilitate the relatively easily and gently placing of the haptic into the lumen with a one-time use of forceps.

RESULTS

This technique was performed on 65 eyes of 58 patients, with a mean patient age of 53.0 ± 14.6 years (range, 22-78). No complications such as endothelial touch, vitreous loss, iris or ciliary body damage, and hyphema were encountered during surgery. The mean operation duration was 14.8 ± 2.3 min (range, 12-20). In the postoperative period, there was only mild postoperative anterior chamber reaction in all eyes. Postoperative transient intraocular pressure (IOP) elevation that responded well to topical antiglucomatous therapy was observed in only two cases (3%). No patient developed haptic exposure, IOL dislocation, iris capture, postoperative hypotony, vitreous hemorrhage, choroidal effusion, cystoid macular edema, or retinal detachment.

CONCLUSION

The facilitated trailing haptic externalization technique provides a safer, simpler, and minimally invasive surgery without significant complications while easing the surgical difficulties of the Yamane technique.