Implantation of scleral-fixated posterior chamber intraocular lenses

A surgical technique for implanting a posterior chamber intraocular lens (IOL) in eyes without capsular or zonular support is presented. A 10-0 polypropylene suture attached to a standard needle is tied to the apex of each haptic and passed transclerally through the ciliary sulcus to secure the haptics at the 3 o'clock and 9 o'clock meridians. This technique produced good visual results in six aphakic patients who were contact lens intolerant, two patients in whom capsular or zonular rupture at the time of cataract surgery precluded standard nonsuture fixation techniques, one patient who had intracapsular cataract extraction for a subluxated, cataractous lens, and one patient who had secondary IOL implantation in combination with penetrating keratoplasty for aphakic bullous keratopathy. Advantages over other techniques of posterior chamber lens implantation in the absence of capsular support include technical ease, avoidance of iris fixation, and more precise placement of scleral fixation sutures, thus minimizing IOL decentration.     

Luxated intraocular lens fixation using anterior chamber slipknot of the haptic to the sclera: a simple procedure to fixate intraocular lens to the sclera

PURPOSE: To describe a technique for suturing a luxated intraocular lens (IOL) in the vitreous cavity directly to the ciliary sulcus using intraocular slipknot without IOL extraction. DESIGN: Noncomparative interventional case series. MATERIALS AND METHODS: A three-port vitrectomy was performed in all cases. According to the Lewis procedure, two scleral flaps and relative sclerectomies were performed at 3 and 9 o'clock position. IOL was rescued from vitreous cavity by means of perfluorocarbon and stabilized in anterior chamber by intravitreal forceps. Corneal endothelium was preserved by a dispersive ophthalmic viscosurgical device coating. Double armed 10-0 polypropylene was introduced into the vitreous cavity through the 9 o'clock sclerotomy incision and both the needles were passed out of the eye by the 3-o'clock position sclerotomy, guided by a bent 27-gauge needle 1.5 mm from the limbus. Hooking the slipknot around the haptics of the IOL in the anterior chamber by means of vitreous forceps, the 10-0 polypropylene was pulled so that the IOL haptic was fixated onto the sulcus. The same procedure was used to fixate the opposite haptic to the ciliary sulcus at the opposite position. RESULTS: In all four cases, the IOL fixated stably and remained well positioned. No significant intraoperative or postoperative complications occurred. CONCLUSIONS: This technique enables secure fixation of the luxated IOL in the vitreous without extracting it.     

Double-knot transscleral suture fixation technique for displaced intraocular lenses

PURPOSE: To describe a simplified new technique for repositioning and attaching a suture to the haptic of a displaced posterior chamber intraocular lens (IOL). METHODS: We describe a double-knot technique for repositioning and transscleral suture fixation of a subluxed posterior chamber IOL after penetrating keratoplasty. Two 10-0 Prolene transscleral sutures on straight needles are passed around the IOL haptic, tied extraocularly, and used to secure the repositioned haptic of the IOL. A second knot ties the transscleral suture in the scleral bed, stabilizing the haptic in the ciliary sulcus. RESULTS: In the case described, the IOL was stable and well positioned 2 months after surgery. CONCLUSION: The double-knot technique for intraocular repositioning and transscleral suture fixation of displaced posterior chamber IOLs reduces the extensive intraocular manipulation and scleral incisions required for IOL exchange and may reduce chronic irritation associated with iris fixation.     

Surgical technique for transcleral-fixation of a dislocated posterior chamber intraocular lens

PURPOSE: To report a cornea-pars plana through-and-through technique for the repositioning and transcleral suture fixation of a dislocated posterior chamber intraocular lens. DESIGN: Interventional case series. METHODS: For transscleral suture fixation of a dislocated posterior chamber intraocular lens, one needle of a double-arm 10-0 Prolene needle is passed through the paracentesis site then underneath the intraocular lens haptic, and through the intended scleral outlet on the opposite side. The other needle of the Prolene suture is also passed through the same paracentesis, above the same haptic, and through the intended scleral outlet on the opposite side. The haptic is now well supported, and the knot is tied. A similar procedure is performed for the second haptic if necessary. RESULTS: Three eyes (three patients) were operated on using this technique with good visual and anatomic outcome. CONCLUSION: The described technique is simple, safe, allows early visual rehabilitation, and can be accomplished without an assistant.     

Repositioning a subluxated sutured intraocular lens in a vitrectomized eye

A simple, effective technique for repositioning a subluxated intraocular lens (IOL) in a vitrectomized eye is reported. A 49-year-old man who had previous pars plana vitrectomy and transscleral suture fixation of a posterior chamber (PC) IOL had lens subluxation caused by slippage of the haptic from a fixation suture. The IOL was dangling in the liquefied vitreous, preventing direct visualization of the displaced haptic. The displaced haptic was directly grasped from the opposite side with an intraocular forceps through a limbal wound and resutured to the sclera. Because only the end-grip intraocular forceps was required, this technique provides anterior segment surgeons an alternative technique of repositioning scleral-fixated PC IOLs.     

Luxated intraocular lens fixation using intravitreal cow hitch (girth) knot

OBJECTIVE: To describe a technique for suturing a luxated intraocular lens (IOL) in the vitreous cavity to the ciliary sulcus using intraocular cow hitch (girth) knots without IOL extraction. DESIGN: Non-comparative interventional case series. PARTICIPANTS: Five patients with a luxated IOL in the vitreous cavity. INTERVENTION: All patients underwent surgery to fixate the IOL using this technique. METHODS: A three-port vitrectomy was performed in all five cases. A needle with looped 10-0 polypropylene was introduced into the vitreous cavity through a sclerotomy incision, and only the needle was passed out of the eye, guided by a bent 27-gauge needle from the 3-o'clock position 1.5 mm from the limbus. A cow hitch (girth) knot at the end of the loop was made outside the globe, grasped with a straight intravitreal forceps, and introduced into the vitreous cavity. Hooking the cow hitch (girth) knot around the haptics of the IOL in the vitreous cavity, the 10-0 polypropylene was pulled so that the IOL haptic was fixated onto the sulcus. After the opposite haptic was brought into the anterior chamber, the 10-0 polypropylene was looped around the haptics of the IOL and manipulated with a push-and-pull hook in the anterior chamber through the two corneal side ports to make a cow hitch (girth) knot outside the anterior chamber. By pulling up the suture, the knot was brought back and tied in the anterior chamber. It was then fixated to the ciliary sulcus at the 9-o'clock position. MAIN OUTCOME MEASURES: Patients were evaluated for visual acuity, refraction, and surgical complications associated with the procedure. RESULTS: In all five cases, the IOL fixated stably and remained well positioned. No significant intraoperative or postoperative complications occurred. CONCLUSIONS: This technique enables secure fixation of the luxated IOL in the vitreous without extracting it.     

Transscleral suture technique for fixation of a dislocated posterior chamber intraocular lens

We describe a double-loop-knot technique for repositioning a displaced posterior chamber intraocular lens (IOL) that facilitates placement of scleral fixation sutures around the haptic for IOL stabilization. The technique minimizes the intraocular manipulations necessary to create a suture loop around the haptic of a dislocated IOL as well as scleral incisions required for IOL exchange.     

Combined suture-in-needle and scleral tunnel technique for scleral fixation of intraocular lens

We describe an intraocular lens (IOL) fixation technique that combines suture-in-needle and scleral tunnel techniques. A 10-0 polypropylene suture is inserted into the barrel of a 27-gauge sharp needle to tie the IOL haptic, and scleral tunnels are created to bury the knots for transscleral IOL fixation. The modification of the traditional scleral fixation technique simplifies the creation of a scleral covering and decreases harmful manipulations of the needle passing through the vitreous cavity.     

Scleral fixation suture technique without lens removal for posteriorly dislocated intraocular lenses

BACKGROUND: Posterior chamber intraocular lenses (IOLs) may dislocate into the vitreous or over the retina at the time of, or several months after, surgery or following injury. Techniques described to reposition dislocated lenses have drawbacks, such as lens removal, lens exchange, difficulties of lens repositioning procedures and high cost We describe a technique in which the haptics of dislocated IOLs are fixed to the sclera after the haptics are externalized solely through a pars plicata incision site and tied with a 10-0 Prolene suture. METHODS: After pars plana vitrectomy, the IOL was grasped with an intraocular forceps and moved to the pupillary area. A second intraocular forceps was inserted from the site of planned fixation, and the tip of the haptic was pulled out and heated to form a knob to avoid suture slipping. A 10-0 Prolene suture was then tied to the haptic by means of a sailor knot The haptic was reinserted intraocularly, and the outstaying sutures were tied with conventional knots over the sclera or under the scleral flaps. The procedure was then repeated on the other side. RESULTS: This technique has been used in 12 patients (12 eyes), 7 men and 5 women ranging in age from 45 to 77 (mean 63.8 [standard deviation 8.5]) years. The time between diagnosis of dislocation and surgery was 10 to 20 days in six cases and 21 to 39 days in six cases. The IOL was dislocated into the vitreous in eight cases (67%) and over the retina in four cases (33%). The preoperative best corrected visual acuity ranged from 20/200 to 20/30. Intraoperatively, mild vitreous hemorrhage developed in two patients (17%), macular edema developed in two patients (17%), and rhegmatogenous retinal detachment developed in one patient (8%). The final visual acuity ranged from 20/50 to 20/20 in 11 patients; the patient with retinal detachment had hand movement vision. INTERPRETATION: The technique of scleral fixation of posteriorly dislocated IOLS without lens removal is a safe, inexpensive and useful complement to other techniques.     

Suture fixation of a foldable acrylic intraocular lens for ectopia lentis.

A 5-year-old boy with severe ectopia lentis had bilateral lensectomy and suture fixation of a foldable acrylic intraocular lens (IOL) through a 3.0 mm clear corneal incision. Sodium hyaluronate (Healon GV) enhanced stability of the crystalline lens during aspiration and maintenance of the anterior chamber during passage of the needles through the ciliary sulcus. The haptic design of the single-piece AcrySof (Alcon) IOL permitted secure fixation of the suture to the haptic. The patient experienced rapid visual rehabilitation, achieving an uncorrected visual acuity of 20/40 in both eyes.     

Surgical technique for repositioning subluxated previously scleral-fixated intraocular lenses

PURPOSE: To describe a repositioning technique of a subluxated scleral-fixated rigid intraocular lens (IOL) with haptic holes in eyes with complete or anterior vitrectomy. DESIGN: Interventional case series. METHODS: Using a two-port pars plana vitrectomy, a 10-0 polypropylene suture with the free end fixated to a haptic hole cut from another artificial IOL is passed through a paracentesis, then through the hole of the haptic luxated in the vitreous cavity. It is then reanchored at the sclera, repositioning the IOL. RESULTS: In the two eyes, visual acuity was restored to pre-subluxation levels. During 6-month follow-up, anatomic and functional results were stable, and there were no complications. CONCLUSIONS: This technique enables repositioning of a subluxated, previously sutured rigid IOL without externalization of the lens or haptics and with good results.     

Suture fixation of iris-claw intraocular lens

We report a technique to surgically manage the damaged haptic of an iris-claw intraocular lens (IOL). An 89-year-old woman initially presented with a subluxated posterior chamber IOL that was exchanged for an Artisan iris-claw IOL. The IOL had been enclavated nasally and temporally, but it deenclavated nasally 4 weeks postoperatively. During surgery to reposition the IOL, 1 haptic of the nasal claw was seen to be damaged. It was sutured to the iris with 10-0 polypropylene using a CIF-4 needle. The postoperative outcome was good. Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned.     

Transscleral intraocular lens fixation with a "homemade" needle and hook

We describe an ab externo, transscleral, intraocular lens (IOL) fixation technique using a surgeon-fashioned 25-gauge hook, a neodymium:yttrium aluminum garnet (Nd:YAG)-modified 27-gauge needle, and 9-0 polypropylene suture. This is a simple, inexpensive technique for creating small-gauge surgical instruments to accurately and atraumatically pass 9-0 and 10-0 polypropylene sutures through sclera. Holes, through which sutures can be threaded, are "burned" near the tips of 27-gauge or 30-gauge needles with an Nd:YAG laser. Using a fine needle holder, a 25-gauge hook is fashioned from a hypodermic needle. A surgical technique incorporating 2 ab externo incisions and achieving transscleral posterior chamber IOL fixation is discussed.     

Transscleral posterior chamber lens fixation. Simplified and time saving technique]

Transscleral suture fixation of posterior chamber lenses is preferred to angle-supported anterior chamber lenses in cases of complicated cataract surgery with loss of the capsule. One of the disadvantages of suture fixation is the time needed to fix the suture to the haptic of the intraocular lens and to the sclera. Up to now it has been necessary for sutures to be tied separately to the haptic of the posterior chamber lens. With a modified one-piece PMMA posterior chamber lens, which has positioning holes at the vertex of the haptic (Morcher G 48), this is no longer necessary. Using a loop technique, it is possible for a specially designed single-arm loop suture (Ethicon X900G/STC-6) to be fixed safely to this new lens without any knots. Fixation of the sutures can thus be performed more easily and quickly, and there is no more danger of the suture slipping off the haptic. For the first time it has become possible to fix the sutures to the haptic without putting the intraocular lens down in the perioperative field. Reducing the manipulation time on the intraocular lens may also reduce the risk of intraoperative contamination.     

Transscleral fixation of a dislocated IOL through sclerotomy

We describe a technique for knotting a suture to the haptic of a dislocated intraocular lens (IOL) through a sclerotomy site without removing an IOL in 4 patients. The suture was knotted to the haptic from outside the sclera. The remaining suture material was tied together and buried in the sclerotomy site. To prove that we could suture to the haptic safely, experiments were carried out using 4 scleral shells of donor eyes. No complications occurred, and good visual recovery was achieved. In this method, the haptic can be tied safely through the sclerotomy site and reduce the risk for knot-related complications. To our knowledge, this approach has not been reported.     

Scleral fixation technique using 2 corneal tunnels for a dislocated intraocular lens

Several techniques are used to reposition dislocated intraocular lenses (IOLs). Most place a suture loop around the end of the haptic. However, in cases of a dislocated capsular bag containing the IOL, a dislocated IOL with a large haptic, or a miotic pupil, it is not easy to see the haptic ends to place the suture loop. We describe a scleral fixation technique that uses 2 corneal tunnels. A double-armed 10-0 polypropylene suture loop can be introduced through 1 corneal tunnel and placed around any accessible part of the haptic with the help of a bent 26 gauge needle. This modified technique is an easy and effective way to reposition the IOL.     

A review of suturing techniques for posterior chamber lenses

PURPOSE OF REVIEW: To evaluate the outcome of last the 15 years' experience with the transscleral suture fixation technique of posterior chamber intraocular lens (PC IOL). RECENT FINDINGS: The implant of an anterior chamber IOL, especially the iris-claw lens, is safer and a better option than the transsclerally fixed IOL. SUMMARY: After bibliographic review of anterior chamber lenses implant results with transscleral fixation, we conclude that the number of complications is less in the iris fixation lens.     

A modified iris repair technique and capsular tension ring insertion in a patient with coloboma with cataracts

PURPOSE: We describe our successful experience using a capsular tension ring (CTR) and iris repair during cataract surgery in a patient with bilateral coloboma. METHODS: A 67-year-old woman had no history of trauma, but had zonular deficiency and inferonasal iris defects in both eyes. An extracapsular cataract extraction and intraocular lens (IOL) scleral fixation was performed in the left eye. A CTR was implanted in the right eye through a sclerocorneal incision. After the IOL was placed centrally in the capsular bag, two paracenteses were made at the limbus (5 o'clock and 7 o'clock). A long, straight needle was passed through the 7 o'clock paracentesis site into a angled, blunt tipped 27 gauge needle inserted from the 5 o'clock paracentesis. The two needles were pulled out at 5 o'clock. After inserting the long needle into the blunt tipped needle at 7 o'clock, both were passed back through the 7 o'clock paracentesis site. The needles were pulled out again at the 5 o'clock paracentesis site tied. Equal tension was used to tie both sides. RESULTS: Visual acuity improved to 20/20 in the right eye. CONCLUSIONS: Both capsular tension ring implantation and iris repair was successfully performed at the time of cataract surgery in a coloboma patient, which resulted in improvements in visual function and cosmesis.     

Endoscopic technique for suturing posterior chamber intraocular lenses

A challenge of the sutured posterior chamber intraocular lens (IOL) technique is to perform blind actions behind the iris. To avoid imprecise transscleral sutures and complications, we use an endoscopic procedure with 2 goals: to control the entry site of the needle penetration and of the haptic location. The endoscopic technique allows retroiris control during transscleral suturing and iridociliary IOL implantation. It is a safe, precise method that avoids the risks of blind procedures behind the iris.     

A new surgical technique using steel suture for trans-scleral fixation of posterior chamber intraocular lenses

Background:

A new emerging complication of trans-scleral fixation of posterior chamber (PC) intraocular lens (IOL) with polypropylene suture is high rates of spontaneous dislocation of the IOL due to disintegration or breakage of suture.

Materials:

We report a new surgical technique of trans-scleral fixation of posterior chamber intraocular lens (SF PCIOL) with steel suture to eliminate the complication of dislocation of IOL fixed with polypropylene suture in one adult and a child.

Results:

We successfully achieved stable fixation and good centration of IOL after SF PCIOL with steel suture in these patient having inadequate posterior capsular support. Both eyes achieved best corrected visual acuity 20/40 at 18 months follow-up.

Conclusions:

Steel suture is a viable option for trans-scleral fixation of posterior chamber intraocular lens.