Abstract
Purpose :
To combine 4-point, flanged polypropylene intraocular lens (IOL) scleral fixation with use of a hydrophobic, aberration-neutral IOL
Methods :
This study comprises an in-vitro component in a model eye and a surgical case series of 9 patients. Using the Envista MX60 and 6.0 polypropylene sutures, 4-point fixation to the sclera was acheived using the flanged-suture technique. Conjunctival peritomies, scleral flaps/pockets, glue, and suture knots were avoided. With the IOL outside the eye, the polypropylene is passed through each eyelet in a proposed novel configuration (LOTO: Loop to Optic and Trailing ends to Outside). The suture line ends are externalized through the pars plana using a regular 30g needle and flanged. The load needed to cause haptic fracture following the LOTO technique was determined in vitro. This load was compared to that of the simple-pass technique which was previously reported as the most resistant to fracture. In addition, scanning electron microscopy (SEM) at the fracture sites was performed to rule out a cheese-wiring effect, which was also previously reported. The main outcome measures were procedure related complications and uncorrected visual acuity
Results :
One incidence of haptic fracture occurred following the first model eye implantation due to excessive suture tension on the haptic (none in humans). The fracture load was similar between the LOTO and the simple-pass techniques (1.08 ± 0.52 N vs 1.09 ± 0.32 N), suggesting no safety compromise. SEM did not disclose cheese-wiring effect.
All cases experienced visual improvement postoperatively with best-achieved-postoperative uncorrected visual acuity of 20/25-20/200, and the IOL was well-centered. Two patients developed post-operative CME treated topically. The first operated case developed extrusion of one flange that was readily repaired in clinic.
Conclusions :
This novel technique adds 2 main advantages to previously described flanged-suture techniques: 1) 4-point fixation of a readily available aberration-neutral, hydrophobic IOL and 2) immediate application at the time of initial complicated cataract surgery since it requires no additional supply, IOL, or instrumentation.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.