Trocar-assisted extraocular technique for intrascleral intraocular lens fixation using a 90°-curved forceps: a modified extraocular forceps-guided technique

Purpose To investigate the surgical outcomes of intrascleral intraocular lens (IOL) fixation using a modified extraocular forceps-guided technique. Study design Retrospective case series. Methods Overall, 81 eyes of 78 patients who underwent intrascleral IOL fixation using the modified extraocular forceps-guided technique were included. The procedure entailed creating 2 scleral half-layer T-shaped incisions perpendicular to the main incision and forming a scleral tunnel. A 25-gauge trocar was inserted at the lower end of the T-shaped incision to perform vitrectomy. A 27-gauge needle was inserted from the left-hand port, and the leading haptic was inserted into the needle lumen. After removal of the right-hand trocar, a 90 degrees-curved intrascleral fixation forceps was inserted into the eye, exposing the tip at the main incision, thus allowing the tip of the extraocular trailing haptic to be gripped and both haptics to be pulled out. The left-hand trocar was removed, and the haptics were buried in the scleral tunnel. The surgical outcomes of this technique were retrospectively evaluated on the basis of the medical records. Results The induction of haptics was successful in all cases. The preoperative best-corrected visual acuity improved from 0.35 +/- 0.68 to 0.12 +/- 0.36 logMAR postoperatively (P<0.01). The refractive error was -0.27 +/- 0.87 D; IOL decentration, 0.39 +/- 0.18 mm; IOL tilt, 5.97 +/- 2.65 degrees; IOL astigmatism, 0.35 +/- 0.36 D; and corneal endothelial cell loss, 10.3 +/- 12.7%. There were no serious complications related to the surgical technique. Conclusion The modified extraocular forceps-guided technique allows for safe and straightforward induction of the trailing haptics and enables the performance of intrascleral IOL fixation with minimal scleral incisions.