Sutureless Technique For Repositioning And Scleral Fixation Of The Capsular Bag–Intraocular Lens Complex With Permanent Use Of Iris Retractors – One Year Results.

To present one-year results of sutureless technique for repositioning and scleral fixation of the capsular bag–intraocular lens (IOL) complex in the surgical treatment of subluxated lenses.  Surgery with the use of a capsular tension ring (CTR) and iris retractors, the ends of which were brought out through the sclera and cauterized, was performed in 15 eyes of 14 patients with moderate or severe subluxation of the crystalline lens. Iris retractors were used to permanently fix the capsular bag to the sclera, without the need to prepare scleral or conjunctival flaps.

Ophthalmology Department, Military Institute of Medicine – National Research Institute in Warsaw, Poland

The phacoemulsification of subluxated cataract with the capsule stabilization with iris retractors was performed in 15 eyes of 14 patients. The CTR and a foldable 1-piece IOL was implanted in the capsular bag. After removing the silicone stoppers, the ends of retractors were put into the lumen of the 25-gauge needle using forceps, externalized  through the sclera and then cauterized. Anterior vitrectomy was performed when necessary. During the follow-up visits, a complete ophthalmic examination was performed including uncorrected visual acuity, corrected distance visual acuity, slitlamp evaluation, tonometry, fundus evaluation, and B-scan ultrasonography.

The surgery was performed in 15 eyes of 14 patients with subluxation of cataractous lens greater than or equal to 90 degrees (mean 160 degrees; SD ± 32.6)  (range 90 to 180). The mean follow-up was 12 months ± 10.2 (SD).  The anatomical and functional results were good. There were no surgical complications that affected visual function during the postoperative period. The mean preoperative and postoperative CDVAs on Snellen chart were 0.32 ± 0.25 (SD) (range 0.01 to 0.8) and 0.62 ± 0.41 (SD) (range: 0.01 to 1.0), respectively.

In this sutureless technique, the normal CTR is used together with cauterized iris retractors, which stabilize the lens capsule at the location of zonular weakness. The method provides a predictable course of the surgical procedure, with a low risk for postoperative capsular bag–IOL complex decentration. No need to create flaps and using sutures or glue in this approach makes the procedure faster, easier to perform, and minimalizes ocular trauma.