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Long-term analysis of IOL stability in Lewis technique for scleral fixation

Session Details

Session Title: Cataract I

Session Date/Time: Friday 14/02/2014 | 10:30-12:30

Paper Time: 10:54

Venue: Kosovel Hall (Level -2)

First Author: : MicheleDe Maria ITALY

Co Author(s): :    Gian Maria Cavallini   Giulio Torlai   Laura Chiesi        

Abstract Details


To demonstrate that in case of absence of capsular support the IOL scleral fixation is both effective and stable through years.


Institute of Ophthalmology, University of Modena & Reggio Emilia, Modena, Italy (Head: Prof. Gian Maria Cavallini).


Retrospective study. 13 eyes from 13 patients have been enrolled in this study. All patients underwent, between January 2001 – December 2008, an IOL scleral fixation according to Lewis suturing technique: instead of creating a scleral flap to cover the knots of the sutures, the surgeon buried the knots within the eye. All patients have been operated by the same experienced surgeon with the same surgical technique for the IOL scleral fixation. All patients underwent a complete ophthalmological evaluation (corrected distance visual acuity CDVA, endothelial biomicroscopy, slit lamp examination) and the IOL stability has been assessed both through a slit lamp examination and an anterior segment OCT. All clinical parameters have been reported and analyzed. Particular attention has been paid to IOL stability which has been evaluated in terms of IOL centration and tilting. All the knots have been photographed with a slit lamp camera and their integrity has been assessed by three independent operators.


The patients’ follow-up ranged from 60 to 129 months. CDVA was 0.46 (±0.42 SD). Endothelial cell density was 2446 (±469.22) cells/mm2. At the slit lamp examination 11 knots appeared to be clearly evident and undamaged, 6 knots were evident but eroded, lastly 9 knots were not detectable. Regarding the IOL stability, the lenses were positioned in the sulcus in all cases. In 2 patients a slight decentration of the IOL has been detected at the slit lamp examination, while the anterior segment OCT imaging demonstrated slight tilting of the lenses in a higher percentage of patients.


The IOL Lewis sulcus fixation is an optimal surgical technique for those cases with an absence of capsular support. Despite the erosion of one or both the knots, the IOL is stable in the sulcus in all the patients. No IOL luxation in the vitreous chamber has been reported, however only 2 of the 10 patients with at least one eroded knot presented a minimal tilting or decentration of the IOL with no influence on visual acuity. All the other minor IOL malpositioning demonstrated not to be clinically significant. Although the effective knot erosion is not an uncommon evenience, the IOL remains stable in the long term, this probably due to a fibrotic process around the suture which prevents the slippage of the suture. FINANCIAL INTEREST: NONE