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M. C. Peden, S. G. Adams, Jr., B. Huffman, H. Adams, S. Kaushal; An Alternative Technique for Implantation of Scleral-Fixated Intraocular Lens. Invest. Ophthalmol. Vis. Sci. 2008;49(13):400. doi: https://doi.org/.
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Implantation of an intraocular lens (IOL) into the capsular bag during cataract surgery is the standard of care; however, surgeons must be comfortable with alternative techniques in the event of complications preventing such placement. Surgeons must assess intraoperatively whether sufficient support exists for placement of the lens within the capsular bag, ciliary sulcus, or anterior chamber. Rarely, inadequate capsular or iris support remains rendering the scleral fixated implant as the only intra-ocular lens option. This paper presents a unique method for placement of such lenses demonstrating easier passage of fixating sutures, more control in suture placement, and the ability to place a pre-tethered lens into the posterior chamber, minimizing the risk of lens dislocation during the implantation procedure.
An ab externo suture approach is used that introduces a loop of prolene through the sclera in a single 27 gauge puncture. The loop of prolene suture is then used to secure the lens haptic in a "hitch" fashion, minimizing risk of knot loosening and subsequent lens dislocation (Figure 1). The lens is introduced into the eye through a superior scleral tunnel wound once both haptics have been secured. Suture slack is removed until the lens is secure and well centered. The externalized curved suture needle is used to make a partial thickness scleral pass and then tied to the other end of suture. Knots are covered with a scleral flap.
The technique results in securing an intraocular lens near the normal anatomic location of the crystalline lens when absence of capsular support precludes non-tethered placement of an IOL in the sulcus or capsular bag. It has been utilized successfully more than a half a dozen times at our institution.
This technique for scleral-fixated intraocular lenses yields successful placement with more efficiency and control than other previously reported techniques.
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