Evaluation of suturless scleral fixation with posterior chamber foldable intraocular lens implantation

AIM: To assess the sutureless scleral fixation technique for posterior chamber foldable intraocular lens(PCIOL) implantation in aphakic eyes with insufficient or no capsular support. METHODS: A technique for sutureless intrascleral fixation of the haptics of a standard 3-piece PCIOL was used which ensures sutureless fixation by permanent incarceration of the haptics in a scleral tunnel parallel to the limbus. All patients were evaluated for preoperative status [visual acuity, refractive error, K readings, intraocular pressure(IOP) measurement, slit lamp examination, fundus examination and optical biometry], postoperative status and complications. Ultrasound biomicroscopy(UBM) was done for 10 cases to evaluate optic tilt. RESULTS: The study evaluated 42 eyes of 42 patients. The follow-up period was 6 mo. Improvement of best corrected visual acuity(BCVA) one line occurred in 10 cases(23.8%) and loss of one line in 3 cases(7.1%). Intraoperative complications included: haptic kink in 4 cases(9.5%), haptic breakage in 1 case(2.4%), haptic dislocation in 1 case(2.4%), haptic slippage in 3 cases(7.1%), IOL dislocation in 1 case(2.4%) and sclerotomy related bleeding in 1 case(2.4%). Postoperative complications included: transient mild vitreous hemorrhage in 3 cases(7.1%), choroidal detachment in 1 case(2.4%), cystoid macular edema(CME) in 1 case(2.4%), optic capture in 1 case(2.4%), subconjunctival haptic in 2 cases(4.8%), ocular hypotony in 4 cases(9.5%) and ocular hypertension in 1 case(2.4%). There were no cases of retinal detachment or endophthalmitis. UBM showed optic tilt in 3 cases(30%). CONCLUSION: Fixation of three-piece foldable IOL haptics in scleral tunnel parallel to the limbus-providedaxial stability and proper centration of the IOL with minimal or no tilt in most cases and a low complication rate during the follow up period which lasted 6 mo.