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

Toric trans-scleral plugs IOL to correct aphakia with significant corneal astigmatism

PURPOSE

To describe the use of toric trans-plugs IOL to correct aphakia with significant corneal astigmatism.

METHODS

Case report and literature review.

RESULTS

A 62-year-old man with an history of aphakia in his left eye after a traumatic cataract extraction and significant corneal astigmatism was referred to our clinic. Surgery plan was cataract remnants removal and secondary IOL implantation of toric sutureless trans-scleral plugs fixated IOL (FIL SSF, Soleko, Italy). The postoperative course was uneventful. At 12 months, the IOL was well-centered and the optic alignment remained stable with minimal total astigmatism. The e uncorrected distance visual acuity (UDVA) was 20/25 Snellen while correct distance visual acuity (CDVA) was 20/20 with a manifest refraction of -0.25-50 40° D; the patient was satisfied by the visual outcome.

CONCLUSION

This novel toric trans-scleral plug fixated lens provides valuable outcomes also for astigmatic correction for a comprehensive correction of the aphakia in patients with poor zonular support and high expectations for postoperative visual quality.

Scleral Fixation of a Toric Lens to Treat Corneal Astigmatism in Eyes without Capsular Support

Purpose

To describe surgical technique and report short-term visual outcomes after suture-fixation of a single-piece eyelet-toric (SET) intraocular lens (IOL) for treatment of concurrent aphakia and astigmatism.

Design

Retrospective, noncomparative, and non-consecutive case series.

Methods

This was a case series of eleven eyes who underwent successful SET. Eligible eyes had loss of capsular support or aphakia with a minimum of symmetric corneal astigmatism 1.75 diopters (D). Outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), magnitude of residual refractive cylinder, and complications resulting from the SET procedure.

Results

Preoperative UDVA and CDVA in logMAR scale were 1.46 and 0.45, respectively. Mean preoperative keratometric and refractive cylinder were 3.67 D and 2.52D, respectively. Postoperative UDVA and CDVA were 0.51 and 0.27, respectively, three months after surgery (POM3). Residual refractive cylinder at POM3 was 0.93 D.

Conclusion

SET technique reduced refractive cylinder and improved UDVA and CDVA. SET may be adapted by surgeons using a readily available IOL and familiar scleral-fixation maneuvers.

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

The procedure involved an ab-externo scleral fixation technique using a double-armed 10-0 polypropylene suture with straight needles that require no scleral flaps. The IOLs are sutured to the sclera, the free suture ends are tied to the suture loops, and they are buried together under the sclera. Forty eyes of 37 patients were included. Postoperative complications are IOL capture in five eyes (12.5%), a significant IOL tilt in one eye (2.5%), recurrent UGH (uveitis-glaucoma-hyphema) syndrome in two eyes (5%), glaucoma in three eyes (7.5%), suture exposure in two eyes (5%) and IOL drop due to haptic breakage in one eye (2.5%). The technique can be effectively used for the refixation of dislocated hydrophobic acrylic IOLs by temporary haptic externalization through a corneal incision and for the treatment of aphakia with or without penetrating keratoplasty. Surgeons should be aware of the possibility of UGH syndrome due to IOL capture, especially in young eyes.

Application of a four-flanged intrascleral fixation technique for toric and multifocal intraocular lenses

Purpose

To report clinical outcomes of a four-flanged intrascleral fixation technique using toric and multifocal intraocular lens.

Observations

We describe two cases of premium intraocular lens (IOL) implantation after which the patients fully recovered their visual function following a four-point sutureless scleral fixation technique via a 2.8-mm corneal incision. In the first case, a monofocal toric hydrophobic lens consisting of two haptic plates with four holes for suturing was fixated with 5-0 polypropylene monofilament. In the second case, a bifocal hydrophobic lens with the same haptic design was fixated. No conjunctival or scleral sutures, glue, or flap formation was required during the surgery. There were no complications related to the surgical process.

Conclusions and Importance

A four-flanged intrascleral fixation technique may benefit patients with poor zonular support who have high expectations for postoperative visual quality.