Sutureless scleral intraocular lens fixation: Report of nine cases and literature review

Purpose. - To report the results of a technique of sutureless intrascleral fixation of a three piece foldable hydrophobic acrylic posterior chamber intraocular lens (PC IOL) in the absence of capsular support and to compare our results to those reported in the literature. Materials and methods. - We report a single-center (Limoges University Medical Center) retrospective series of nine patients with deficient posterior capsular support who underwent sutureless sulcus fixation of a hydrophobic acrylic Tecnis Aspheric (R) model ZA9003 (AMO, Inc.) PCIOL using permanent incarceration of the haptics in scleral tunnels parallel to the limbus, between November 2010 and November 2011. All patients were evaluated for surgical indications, pre- and postoperative refractive status (visual acuity and corneal cylinder), and intra- and postoperative complications. Results. - We included six men and three women with post-traumatic subluxed IOL's in three cases and lack of iris and capsular support secondary to traumatic corneoscleral wounds in six cases. Mean age was 63.22 +/- 18.79 years. Posterior vitrectomy was performed in all cases. Mean 3 month postoperative visual acuity was 0.42 +/- 0.16 LogMAR, and mean corneal postoperative astigmatism was 1.39 +/- 0.78 diopters. Complications included IOL decentration of 1.5 mm in one case, haptic rupture requiring intraoperative IOL exchange in one case, and transitory postoperative macular edema in two cases. Discussion. - Artificial intraocular lens implantation in the absence of capsular support is always a surgical challenge. Currently, the two most widely used approaches include fixation to their is by suturing or iris claw, and fixation to the sclera with sutures. However, these techniques require wide corneal or scleral incisions resulting in significant postoperative astigmatism. Furthermore, iris fixation is impossible in cases of significant iris trauma, and scleral sutures are often technically difficult and expose the patient to late IOL dislocation or tilt. Sutureless intrascleral fixation of foldable hydrophobic acrylic three-piece IOL's inserted through a conventional sub 2.8 mm clear corneal incision is a recent technique. This technique is compatible with cases of iris trauma and allows sutureless fixation of the haptics in scleral tunnels parallel to the limbus, while minimizing the risk of postoperative astigmatism. In addition, it allows the repositioning of IOL's dislocated into the vitreous without re-opening the corneal incision. Complications are mainly related to IOL manipulation and positioning. Conclusions. - Results obtained after sutureless intrascleral PCIOL implantation showed good visual outcomes with minimal complications in eyes with deficient capsular support. (C) 2013 Elsevier Masson SAS. All rights reserved.