Scleral fixation of toric IOLs
First Author: OlivierLe Quoy FRANCE
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Corneal astigmatism . is frequently associated with capsular deficiencies requiring scleral fixation IOL’s such as traum, eventfull phaco, Marfan syndrome and lens or IOL luxation.
: Private/Hospital practice
14 patients were operated on between may and october 2013 for lens or IOL luxation with scleral fixation of toric IOL’s (astigmatism varied from 1.75 to 4 diopters). Our series includes 5 cases of high myopia, 3 cases of pseudoexfolliation , 3 cases of ocular trauma, 4 cases of eventful phaco and one case of Marfan syndrome. Mean age was 70 years old (44-84). IOL power calculation by raytracing.
A 25 gauge posterior vitrectomy is associated with a sutureless sclerocorneal incision (3.2 mm wide). Incision positioning in the superotemporal quadrant depends on astigmatism axis which is marked with ink. Luxated IOL was moved in the pupillary aera by active aspiration with a silastic coated canula and its optic cut and extracted through anteroior incision. Eventually, vitrectomy performs peripheral retina examination, sulcus localization by transillumination and superior iridotomy. Implantation is done with an hydrophobic monobloc IOL, 6 mm diameter optic and 13 mm overall haptics angulated at 5°. Each haptics is fixated with 2 sutures placed at their very end, 1 mm wide apart of 10/0 Prolene located in the sulcus and sutured 2 by 2 on the adjacent sclera.
In all but one of the cases, astigmatism was totaly corrected. In one case only partialy due to too high power. The right spherical correction was reached in all cases. In this short series we had no complication due to implantation technic. No ocular hypertension, no rétinal detachment and no endophtalmitis. Postoperative visual acuity depended on the macular function
In case of capsular defects, and when necessary toric lenses can be sclerally sutured with perfect functionnal results and no risk of secondary dislocation. Beyond our expérience, sutured fixation could be used in case of very high astigmatism as soon as such toric IOL’s will be produced. FINANCIAL INTEREST: NONE