The Right Lens For The Right Case: Lens Exchange Of A Malpositioned Hydrophilic Double C-Loop Haptic Iol Due To Intraocular Suture Failure And Anisometropia

To present the surgical resolving of a 58-year-old which presented with IOL subluxation due to previous suture failure and anisometropia. The lens was displaced with the C-loop haptic visible behind the iridectomy in the sulcus plane and the rest of the lens body deviated posteriorly, with a short suture connecting the IOL haptic to the sclera with tent-like anterior iris displacement near the suture. Lens exchange with explant trough 3mm paracentesis using IOL scissor and sutureless scleral fixation of a three-piece IOL using 27G guide needle was performed. The haptics were enclaved in scleral pocket extensions for enhanced stability. Final UCVA was 0.6 decimal with uneventful postoperative evolution.

Department of Ophthalmology, Clinical Hospital for Ophthalmological Emergencies Bucharest, Romania.

“Carol Davila” University of Medicine and Pharmacy Bucharest.

The 58-year-old patient presented IOL right eye (OD) subluxation due to previous suture failure and anisometropia. BCVA was 0.25 decimal, OD refraction -4.25 D Sph -1D Cyl 153°; OS +1D Sph; IOP 16mm Hg. Clinical examination revealed deformed, central pupil and a large superior surgical iridectomy. The lens was displaced with the double C-loop haptic visible behind the iridectomy in the sulcus plane and the lens body posteriorly. A short haptic-sclera suture through the lens bag was the lone IOL anchor. The lens bag material was clear and diaphanous. Intraoperatively scleral pocket flaps were created 180° apart, 3mm from the limbus measuring 3mm. Anterior vitrectomy aspirated vitreous strands around the IOL. After placing the free haptic over the iris plane and injecting OVD the lone suture was cut. The IOL was explanted trough 3 mm paracentesis using IOL scissor to partially cut the optic in the center. A 27G guide needle was inserted from the scleral pocket into the anterior chamber. The first 14.00D three-piece IOL haptic was injected intraocularly externalized with the 27G guide-needle, similar to Yamane technique. IOL implantation was finalized with externalization of the second haptic in a similar fashion. Scleral pocket extension in the haptic directions were performed; the haptics were then enclaved into the extended scleral pocket for sutureless scleral-fixation. The suprajacent conjunctiva was sutured. UCVA was 0.6 decimal with uneventful postoperative evolution.

Scleral fixation using intraocular sutures for resolving surgical aphakia without capsular support is effective, however smaller suture sizes are susceptible to failure over time. In this case an unsuitable C-loop hydrophilic IOL was used with a peculiar haptic-sclera suture, with failure of the suture afterwards leading to IOL subluxation and secondary glaucoma. The lens bag material suggested previous Dead Bag Syndrome. The lens had to be explanted and a three-piece IOL inserted for a more stable, sutureless scleral fixation technique, providing the required IOL stability in this case. We strongly recommend the per primam selection of a complete, adequate and strong IOL suture technique, with our technique as a stable reserve solution.