Abstract

SA.02.04

Sutureless intrascleral PCIOL fixation

Pavlidis M., Scharioth G. B.
Augenzentrum Recklinghausen

Objective: There are different options for intraocular lens implantation in the absence of sufficient capsular support: AC IOL, irisfixated IOL and suturefixated PC IOL. We developed a technique for sutureless intrascleral fixation of the haptics of a standard three piece PCIOL.
Methods: After standard three port pars plana vitrectomy and preparation of corneal incision for injector-assisted IOL implantation two straight sclerotomies are prepared with a 24G cannula 2.0 mm from the limbus exact 180° to each other. Then this cannula is used to create a 2.0-3.0 mm long limbusparallel tunnel starting from the sclerotomies. A standard three-piece intraocular lens is implanted with an injector and the tailing haptic is fixed in the corneal incision. The leading haptic is then grasp at its tip with an end gripping 25G forceps and pulled through the sclerotomy. Then this forceps is introduced in the distal end of the limbusparallel tunnel and while grasping the tip, the IOL haptic is pulled into the tunnel. After intraocular luxation of the tailing haptic again the tip is grasp with the 25G end gripping forceps and pulled through the second sclerotomy. Finally the tailing haptic is introduced into the limbusparallel tunnel and with final positioning the IOL is centered. We report intraoperative and postoperative course of an initial series of 20 cases.
Results: Except difficulties in the intrascleral positioning of the forceps no intraoperative complications occured. All IOLs were stable and centered. Potential complications of transscleral fixation of PC IOLs include suture erosion, suture knot exposure and recurrent dislocation caused by a broken suture could be avoid by sutureless technique, used in our cases. There were no cases of endophthalmitis, vitreous hemorrhage, retinal detachment, cystoid macula edema or glaucoma.
Conclusions: This technique simplifies scleral fixation of PC IOLs and allows successful repositioning of dislocated and subluxated PC IOLs. Furthermore this technique can be performed with a standard three piece PC IOL without need of special haptic architecture or preparation or the need for storage or ordering special IOLs for rare indications.

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