Results With The Repositioning And Scleral Fixation Of The Capsular Bag - Intraocular Lens Complex

To evaluate the results obtained after the scleral fixation of the capsular bag-intraocular lens (IOL) complex with the technique described by Dr. Assia with the modification of Dra. de Rojas.

Hospital Galdakao-Usansolo (Bilbao, Spain), Miranza COI (Bilbao, Spain)

We have evaluated 35 patients who presented 2 and 3 degree subluxations of the capsular bag-IOL.  In this technique, we mark 2 points, separated 180º, making sure they are close to the optic-haptic junction. Afterwards, we make a paracentesis confronting each point. We mark 1.5 and 2mm from the point, in a radial direction. We insert a 30G ultra-thin wall needle at 2mm, under the superior haptic, perforating the merged capsules. Through the paracentesis, we pass the 6-0 prolene suture and put it in the needle to externalize it. We repeat the same process at 1.5 mm (the needle goes over the haptic). Then, we do the same maneuver with the inferior haptic. We  adjust the position and, with a cautery, perform a flanged scleral fixation.

The main cause of subluxation was pseudoexfoliation, followed by personal history of vitrectomy.  We have obtained corrected visual aquities similar to the ones the patients had before the subluxation. The refraction did change in some patients, probably secondary to changes in the effective lens position. Two patients had to undergo a second surgery due to significant tilt. In both of them, we performed Yamane technique with excellent results. We are also analizing the tilt with anterior segment OCT.

The repositioning of the capsular bag-intraocular lens complex with this technique seems to be a good alternative to the explant + secondary implant in patient with 2 and 3 degree subluxations.