Needle-guided scleral fixation IOL: easy technique for beginner surgeons

To propose a very safe and efficient method for scleral fixation IOL applicable in all cases of aphakia and dislocated or subluxated lens and malpositioned IOL. This method is suitable for both experienced and inexperienced surgeons eliminating the need for a vitreoretinal surgeon, trocars or the risk of haptics rupture.

Methods: Fifteen patients, each with dislocated lens or subluxated lens, aphakia pr malpositioned IOL in one eye, underwent transscleral needle-guided fixation of a PMMA single piece IOL. A long needle (e.g. CTC-6L, STC-6 or CIF-4) was inserted into a 24-gauge cannula. This assembly was passed from superotemporal sclerotomy (3 mm from the limbus) to superonasal sclerotomy (3 mm from the limbus). The needle was then loaded with double armed polypropylene 9-0 suture which passed through and emerged from the superotemporal incision, thus creating a single suture strand from nasal to temporal sides, each end carrying a needle -one straight and the other curved. The suture’s extremities were knotted to the haptics of the single piece PMMA IOL’ loops and inserted into the AC through a 6 mm corneal incision, applying torsional forces in opposite directions, making the IOL less easily tiltable. Sutures were placed both on the sclera and cornea after the implant. Results: Visual acuity was of 0.1 Logmar in every patient on day one after the procedure. No IOL tilting was noted. Mild conjunctival hyperemia was present in 70% of the eyes. Conclusion: the needle-guided scleral fixation IOL is a highly safe and effective technique, even for a two-time surgery, in all cases of aphakia, dislocated/subluxated lens and malpositioned IOL. The pros of this technique are the safety of non tilting of the IOL, the absence of risk for subsequent vitrectomy due to IOL dislocation into the vitreous chamber and, its ease of reproducibility even for inexperienced surgeons.