Four-Flanged Intrascleral Intraocular Lens Fixation Technique: No Flaps, No Knots, No Glue

To report the clinical outcomes of a new technique for transconjunctival intrascleral fixation of an intraocular lens (IOL).

To investigate the long-term visual outcome and the complication rate following transscleral suture fixation of posterior chamber intraocular lenses (sutured PC-IOLs). A retrospective case-series descriptive study. Records of patients who underwent combined pars plana vitrectomy and sutured PC-IOLs at Moorfields Eye Hospital and who had at least 12 months of follow-up were examined for recorded complications. Sixty-one eyes of 48 patients (33 males and 15 females) were identified and included in the analysis, with mean follow-up of 6 years. The mean final best-corrected visual acuity remained at preoperative levels (P=.211) and was largely determined by the underlying ocular pathology before sutured PC-IOL. Overall 30 of 61 (49%) eyes, two or more procedures were performed to reverse a significant peri- or postoperative complication. Breakage of polypropylene sutures was the main indication accounting for 17 of 30 (57%) of those reoperations. Subgroup analysis showed that younger patients were more likely to suffer the above complication (P=.009). The multivariate analysis also showed that longer follow-up was significantly associated with suture breakage (P=.014), with the mean time to breakage approximately 4 years after surgery. Long-term follow-up of patients undergoing sutured PC-IOLs appears to be associated with a high rate of postoperative complications and significant need for further surgery, which should be discussed during their informed consent process.

To examine a recent series of late scleral-sutured posterior chamber intraocular lens (PCIOL) dislocations to identify possible causes and preventive measures. Price Vision Group, Indianapolis, Indiana, USA. In this retrospective non-comparative interventional case series, 5 consecutive patients received treatment for dislocated scleral-sutured PCIOLs between July 2002 and March 2004. Dislocated lenses were resutured or replaced with another scleral-sutured PCIOL. Dislocation of scleral-sutured PCIOLs occurred 7 to 14 years after implantation. Four dislocations were spontaneous, and 1 was precipitated by trauma. In each case, the suture affixing 1 or both haptics failed. There was no evidence that the suture had eroded through the tissue or that the knot had untied. Microscopic analysis of an explanted IOL with remnants of the suture attached showed localized degradation and cracking of the polypropylene suture material where it had been embedded in the scleral tissue. Suture-fixated PCIOLs can dislocate due to degradation of the suture material over time. The use of larger diameter (9-0 instead of 10-0) polypropylene suture material and placement of the haptic and sutures in the ciliary sulcus to promote attachment of scar tissue may enhance the long-term stability of scleral-fixated PCIOLs.