Introducing A Novel Transscleral Intraocular Lens Fixation Technique Using Haptic Bending

To evaluate IOL centration and refractive outcome of a novel transscleral fixation technique using haptic bending and comparison to the conventional Yamane technique.

Department of Ophthalmology and Optometry, Kepler University Clinic Linz 

We performed an evaluation of a novel surgical technique for secondary IOL implantation. In this haptic bending technique, the last 1mm of the PMMA haptic were bend prior to implantation. The IOL is then implanted in the anterior chamber and the leading and trailing haptic externalized via a hand shake technique through a 27G sclerotomy. We compared the post-surgical differences between the flanged haptic (using the Yamane technique) and the haptic bending technique regarding following parameters: IOL tilt, IOL decentration, target refraction and BCVA. Measurements were performed six weeks postoperatively with refraction and BCVA testing as well as OCT based measurement of IOL tilt and decentration using a SS - OCT (CSO, MS 39). 

31 eyes of 31 patients were included in this analysis (11 female, 20 male patients). Reasons for secondary IOL implantation: (sub)luxated IOL (n=20), complicated phako (n=7), other reasons (anterior chamber IOL, aphakia, trauma) (n=4). Bending techniqe was performed in 17 cases and flange of the haptic in 14 cases. In terms of biometric data there were no statistical differences preoperatively. Postoperative IOL tilt (bending group: 8.1°; SD 2.9°, flange group: 8.8°; SD 3.9°), decentration (bending group: 0.45mm; SD 0.2mm, flange group: 0.4mm; SD 0.3mm), BCVA (bending group: 0.8; SD 0.4, flange group: 0.7; SD 0.4) and MAE (bending group: 0.4; SD 0.4, flange group: 0.6; SD 0.4) showed no statistical difference, respectively. 

Using the bending the haptic technique is a useful alternative to the conventional flange. Torsion of the PMMA haptic during fixation can be avoided; also there is no need of a needle for haptic externalisation. In high myopia bending may be useful to avoid flange luxation. In our study group there were no signs of conjunctival or scleral irritation and none of the patients had severe intraocular inflammation. A further possible advantage is the possibility of easier re-adjustment in case of significant decentration.