Aphakia Correction Without Capsular Support Using An Injected Lens Fixed To The Sclera With Gore-Tex.

The main objective of the study is to evaluate the efficacy and safety of a new intraocular lens (IOL) implantation technique in aphakic patients without capsular support, in which injector and Gore-Tex sutures are used.

The secondary objectives of the study are to describe the surgical technique, and to analyze the intraoperative and postoperative complications associated with it.

In the management of aphakia without adequate capsular support, multiple innovative surgical techniques have been developed. In absence of concurrent visual disease, achieving similar visual results and complication rates to standard cataract surgery should be a goal. However, there are no studies presenting a series of cases in which the correction of aphakia is carried out by performing Pars Plana Vitrectomy and by implanting the lens using injector and Gore-Tex sutures.

We included patients in aphakia without capsular support with indication to surgical correction, excluding those with another cause of decreased visual acuity prior to surgery.

Pars Plana Vitrectomy and implantation of an IOL with four eyelets for scleral fixation (Akreos Adapt AO) were performed using Gore-Tex sutures marked with knots. IOL was introduced using an injector through a 2.2 mm corneal incision. Four scleral stents were placed 3 mm from limbus in the 2^nd, 4^th, 8^th and 10^th meridians to extract each end of the suture. Incomplete thickness scleral pockets were made between the sclerotomies to hide the suture and prevent conjunctival erosion.

Data were collected prospectively in a digital table and analyzed using SPSS.

20 patients underwent surgery. 5 of them also required iris reconstruction.

In all cases, the correct positioning and centering of the lens was achieved, and this remained stable after a mean follow-up time of 7,4 (2-18) months.

Mean postoperative visual acuity (VA) without correction was 0.46 (0.1-1) and best corrected VA was 0.67 (0.12-1). In 7 cases, uncorrected VA was equal or greater than 0.5. All cases showed postoperative VA improvement.

No intraoperative complications associated with the surgical procedure were found.

Regarding postoperative complications, cystic macular edema appeared in a patient who underwent combined surgery with iris reconstruction. The edema subsided after an intravitreal injection of Ozurdex.

The lens implantation sutured to sclera with Gore-Tex is a safe technique with satisfactory visual results that has been used for several years. The use of an injector to introduce the lens with Gore-Tex sutures implies an improvement in the surgical procedure as it allows reducing the size of the incision as well as the postoperative astigmatism.

The 4-eyelet lenses implanted with the technique described in this study have remained centered, stable, and without tilting throughout follow-up. The rate of complications associated with our surgical technique is low, and similar to the rate of complications presented in patients undergoing standard cataract surgery.