Retrospective Review of Sutured Foldable Lenses Using a Small Incison Approach

Abstract

Abstract: : Purpose: We describe a technique to insert a foldable acrylic intraocular lens through a small scleral tunnel incison and suture the lens into the ciliary sulcus as part of a pars plana vitrectomy. A two year case series is reviewed. Methods: The standard inferotemporal infusion line is placed so that the eye has a constant pressure throughout the procedure. Two spots one superonasal and one inferotemporal exactly 180 degrees apart are marked on the sclera 1.5mm posterior to the edge of clear cornea, and an MVR blade is used to make the sclerotomies. Vitrectomy can be performed for various reasons such as to repair the effects of trauma or to perform a pars plana lensectomy. A 4.1mm scleral tunnel incision is made superiorly. A double armed 10-0 prolene suture with long straight (STZ-1) needles is introduced into one sclerotomy and a bent 27 gauge needle is used to dock the needle and pass one end of the suture through the other sclerotomy. Now each sclerotomy has a straight needle with prolene. The prolene across the center of the pupil is externalized through the tunnel and cut. The haptic tips are melted using a low temperature hand held cautery so the ends become bulbous. Each free end of prolene suture is tied around one haptic and the lens is carefully folded in a taco fashion then placed into the eye. Tension is placed on each end of the prolene suture equally so the lens is brought into an ideal palace in the sulcus free of tilt or decentration. When the lens is positioned, the tips of the the straight needles are bent with needleholders. These curved needles are passed through the sclera at the superior or inferior ends of the working sclerotomies, and the anchoring sutures are tied to themselves. After the suture is cut, the ends are left 3mm long and laid flat or placed in the sclerotomies. The knots are buried in the sclerotomies. Results: Visual acuity improved at one month after surgery in eight out of ten eyes. Preoperative visual acuities ranged from 20/70 to light perception, while one month postoperative visual acuities ranged from 20/20 to hand motions. Complications included one intraocular lens capture from preexisting sector iridectomy, and one wound leak causing choroidal effusions which resolved after wound closure. Of note, none had the frequently reported complication of sutures eroding through the conjunctiva when examined a year after surgery. Conclusions: This is an effective method for suturing a foldable lens into the sulcus after a vitrectomy has been performed.

Keywords: vitreoretinal surgery • clinical (human) or epidemiologic studies: sys • small incision cataract surgery