Technique
Sutureless intrascleral fixation of intraocular lens through self-sealing sclerotomy wounds using haptic externalization and reinternalization technique

https://doi.org/10.1016/j.jcrs.2019.06.019Get rights and content

In eyes with absent or insufficient capsule support, three-piece posterior chamber intraocular lens (PC IOL) may be fixed to the sclera. Previous techniques involve the use of sutures, flaps, glue, needles, trocars, or intrascleral tunnels to fixate the distal tips of the haptics intrasclerally. Herein we describe a modified technique for the sutureless scleral fixation of a standard 3-piece PC IOL using self-sealing sclerotomies created with a crescent blade and a 20-gauge microvitreoretinal blade, and then reinserting the haptics to leave the tips inside the vitreous cavity. We believe the relative simplicity of this technique makes it widely applicable for the placement of an IOL with insufficient capsule support.

Section snippets

Surgical technique

A standard three-port 23-gauge or 25-gauge pars plana vitrectomy is performed with careful depressed vitrectomy to trim the vitreous base.

Discussion

An eye with insufficient or no capsule support might do well with an anterior chamber IOL, an iris-sutured or iris-fixed anterior chamber IOL, or a scleral-fixated posterior chamber IOL (PC IOL). A scleral-fixated PC IOL might be anatomically preferable because the IOL is closer to the native lens position, away from angle structures and the corneal endothelium. Suturing a PC IOL to the sclera is effective, although the suture might cause inflammation and suture erosion can occur. Suture

Presented at the Canadian Ophthalmological Society Annual Meeting, Victoria, British Columbia, Canada, June 2015.

Disclaimer: The views expressed in this manuscript are the authors, and not an official position of McGill University.

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