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Mark Barakat; Modified Sutured Intraocular Lens Technique: Description and Case Series of Early Results. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5938.
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© ARVO (1962-2015); The Authors (2016-present)
In complicated cataract cases, sutured intraocular lenses (IOLs) closely simulate the optimal placement without need for capsular support. A commonly described technique involves the four point fixation of a foldable acrylic lens with nasal and temporal sutures, subject to decentration and folding/distortion of the haptics, based on the position and tension of the two lateral sutures. A modified technique that is independent of suture tension and allows for easy centration and greater surgical flexbilitiy is described.
Illustration of a modified surgical technique as well as a retrospective chart review of the first 3 consecutive cases with early outcomes. Patient demographic data, as well as pre-operative and early post-operative visual acuities (VA) and intraocular pressures (IOP) were noted. Longer term follow-up of post-operative results, not available at the time of abstract submission, to follow.
Three patients underwent secondary placement of a sutured IOL in one eye each, one for post-traumatic aphakia, two for dislocated IOL. Patient A had a superior trabeculectomy bleb and an inferior tube shunt, limiting surgical access to the sclera and cornea to the temporal and nasal quadrants only. Patient B had already undergone a prior IOL exchange, however one haptic had disengaged from the optic post-operatively. Patient C had aphakia, corneal scar, iris damage and vitreous hemorrhage after repair of penetrating trauma.The acrylic lens was fixated laterally using the four haptics, however a continuous "running" Gore-tex suture was employed. There was sufficient access to create the continuous loop suture both with a temporal approach (patient A) as well as a superior approach. Final adjustment/centration of the IOL was performed with the haptics oriented superior/inferior on the latera tracks of the suture.Pre- and post-operative day 1 and week 1 VA was 20/70, 20/50, and 20/60 in patient A, 20/100, 20/150, 20/50 in B, and remained Hand Motions throughout in C. All IOLs were centered, and the VA improvement at last check was 0.12, 0.3, and 0 logMARs respectively. IOP were stable at last check (6, 18, and 25 mm Hg respectively). No early post-operative complications were noted.
A modified sutured lens technique that allows for final centration independent of suture tension is presented. Early outcomes revealed well-centered IOLs with no complications.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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