Four-point scleral fixation of posterior chamber intraocular lenses without scleral flaps

Purpose To report the visual results and complications of a new technique for scleral fixation of posterior chamber intraocular lenses (IOLs) without scleral flaps. Methods Half-thickness 3 mm scleral grooves 1 mm behind the limbus were constructed opposite to each other. The straight needle with a double-armed 10/0 prolene suture was introduced at one end of the scleral groove to exit through the corneal incision then passed through the two holes of the IOL. It re-entered the globe through the corneal incision and then passed behind the iris to exit the globe at the other end of the scleral groove. The same was repeated on the other side. The corneal section was enlarged, the IOL was implanted, and the two ends were tied to each other to form a loop that was rotated and buried in the scleral groove. Results The study included eight men and seven women. Their ages ranged from 7 to 69 years (mean 40+/-21.53 years). The preoperative best corrected visual acuity (BCVA) ranged from 3/60 to 6/9. The operation time ranged from 25 to 50 min (mean 34.55+/-7.66 min). Anterior vitrectomy was performed in nine (60%) cases. Ciliary bleeding during needle passage occurred in six (40%) cases and accidental suture cutting during section enlargement occurred in one (6.7%) case. There was no major IOL decentration. The final UCVA ranged from 6/24 to 6/18 and the final BCVA ranged from 6/24 to 6/9. Five cases (33.33%) showed postoperative glaucoma and three cases (20%) had mild to moderate vitreous haemorrhage. No cases of suture erosion, postoperative endophthalmitis, retinal detachment or IOL dislocation were detected. Conclusion This technique of four-point scleral fixation of posterior chamber IOLs reduces the operation time, achieves good centration and stability of the IOL, and minimises postoperative suture-related complications.