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Reinforced scleral fixation of foldable intraocular lens by double sutures: comparison with intrascleral intraocular lens fixation

  • Clinical Investigation
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Abstract

Purpose

The purpose of this study is to describe a new technique for small-incision scleral fixation of intraocular lens (IOL) using double 10-0 polypropylene sutures, and to report the outcomes of IOL position compared with intrascleral IOL fixation at 12-month follow-up.

Study design

A retrospective comparative study.

Method

This new technique, called double sutured scleral fixated-IOL (DSF-IOL), was created to help with long-term knots strengthening by applying double sutures to each IOL haptic using an augmented Clove-hitch knot instead of the conventional knots tied by single suture. The tilt and decenter of IOL were measured by Scheimpflug camera and other refractive outcomes were compared between two groups at 12-month follow-up.

Results

This study consisted of 26 eyes (54.2%) from the DSF-IOL group, and 22 eyes (45.8%) from the intrascleral fixated IOL (ISF-IOL) group. No significant differences of mean absolute degree of IOL tilt (2.90 ± 0.77 vs 2.82 ± 0.72; p = 0.633) and IOL decenter (151.90 ± 59.80 vs 175.0 ± 73.14 microns; p = 0.265) were found between the two groups. Post-operative LogMAR visual acuity was not statistically different between the two groups (0.32 ± 0.17 vs 0.41 ± 0.19, p = 0.089). Early post-operative hypotony was only present in the ISF-IOL group (13.6%).

Conclusion

This study shows that DSF-IOL is as effective as ISF-IOL. This technique can be a simpler approach to optimize small-incision scleral fixation of IOL without the complications associated with intrascleral IOL fixation.

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Acknowledgements

This study has received Funding supported from Navamindradhiraj university, Bangkok, Thailand. We would like to extend our appreciation to Mr. Jason D. Cullen B.Sc., BA and Ms. Punthita Sakuntanaga for their work on grammar check. Mr. Cullen is also a voice narrator for the surgical video. Finally, the completion of this study could not have been possible without a help of Dr. Chavanant Sumanasrethakul who is our consultant of methodology.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, 681 Samsen Street, Dusit, Bangkok, 10300, Thailand

    Yodpong Chantarasorn

  2. School of medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Street, Bangkok, 10300, Thailand

    Settapong Techalertsuwan, Pongsavit Siripanthong & Anurak Tamerug

Authors
  1. Yodpong Chantarasorn
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  2. Settapong Techalertsuwan
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  3. Pongsavit Siripanthong
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  4. Anurak Tamerug
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Corresponding author

Correspondence to Yodpong Chantarasorn.

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Conflicts of interest

Y. Chantarasorn, None; S. Techalertsuwan, None; P. Siripanthong, None; A. Tamerug, None.

Electronic supplementary material

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Supplementary material 1 (TIFF 73939 kb)

10384_2018_579_MOESM2_ESM.mp4

This VDO demonstrates new surgical technique call double sutured scleral fixated intraocular lens. The small area of conjunctival peritomy were oppositely made at 3 and 9 O’clock. In order to remove lens material, pars plana vitrectomy and fragmentation were done after stabilizing the globe by an infusion cannula. The foldable 3-piece IOL was placed on the center of cornea in order to determine the axis of horizontal scleral grooves which were subsequently made 1mm in length. A 26 gauge, half inch bent needle was passed through the 3 O’clock partial-thickness scleral incision 0.75mm from limbus. Meanwhile, a curved PC-9 needle attached with looped 10-0 polypropylene was introduced into anterior chamber through the 3.0 mm corneal incision and inserted into the 26G needle hole and externalized through the radial scleral incision. It was detached from 26G needle leaving looped polypropylene sutures outside the superior corneal wound. The same procedures were applied in 9 O’clock meridian. The foldable 3-piece IOL was injected through corneal wound leaving one haptic outside the eye. Loop of double polypropylene sutures were tied to externalized haptic 2mm from the tip by using augmented Clove-hitch knot. The second haptic was externalized by clockwise rotation using iris spatula and Lester lens manipulator. Same procedure was applied to second IOL haptic. The PC-9 needles were passed through partial thickness of sclera posteriorly and simultaneously pulled both sides to center the suspended IOL. Both double sutures were tied to themselves. The suture tails were hidden beneath posterior tenon. The infusion cannula was removed. Tenon and conjunctival peritomy were closed. (MP4 25378 kb)

Supplementary material 3 (PDF 81 kb)

Supplementary material 4 (PDF 195 kb)

Supplementary material 5 (TIFF 57 kb)

Supplementary material 6 (PDF 40 kb)

Supplementary material 7 (PDF 470 kb)

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Chantarasorn, Y., Techalertsuwan, S., Siripanthong, P. et al. Reinforced scleral fixation of foldable intraocular lens by double sutures: comparison with intrascleral intraocular lens fixation. Jpn J Ophthalmol 62, 365–372 (2018). https://doi.org/10.1007/s10384-018-0579-4

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  • DOI: https://doi.org/10.1007/s10384-018-0579-4

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