Transcapsular Scleral Fixation For Zonular Dehiscence With Lens Subluxation: A Case Report
Published 2024 - 42nd Congress of the ESCRS
Reference: CC01.03 | Type: Case Report | DOI: 10.82333/n1gg-p246
Authors: Costanza Rossi* 1 , Massimiliano Borselli 1 , Andrea Taloni 1 , Alessandra Mancini 1 , Vincenzo Scorcia 1 , Andrea Lucisano 1
1Department of Ophthalmology,University Magna Graecia of Catanzaro,Catanzaro,Italy
Purpose
To report the surgical management of a subluxated nuclear cataract with partial scleral fixation of a single piece intraocular lens (IOL).
Setting
Ophthalmology Department, Univeristy "Magna Graecia" of Catanzaro
Report of case
An 80 year old female was referred to our center for left eye cataract surgery. Preoperatively, best corrected visual acuity (BCVA) was 20/80 and intraocular pressure (IOP) was normal. Slit lamp examination revealed a shallow anterior chamber, a dense nuclear cataract (N3, LOCSIII) and an area of zonular dehiscence of approximately 150° in the inferior section with lens subluxation.
Intraoperatively, a 25-gauge valved trocar was inserted in the infero-nasal quadrant. After capsulorhexis, hydrodissection was performed without lens rotation. Two capsular hooks were positioned inferiorly to stabilize the capsular bag and a phaco-chop was performed without nucleus rotation. Following aspiration of cortical masses, a 27-gauge bended needle was introduced through the conjunctiva and sclera 2mm posterior to the limbus, and into the subluxated capsular bag. A 6.0 prolene suture threaded through the IOL haptics were inserted into the capsular bag, introduced into the needle and pulled throughout the sclera. The single piece hydrophilic IOL was then injected in the capsular bag and the prolene sutures were cauterized on the scleral side to create a terminal knob. The procedure was then executed in accordance with established standards. One week postoperatively, BCVA was 20/20 (cyl -0.75), IOP was 16mmHg. Prolene sutures were well positioned and the IOL was in the bag. Eighteen months postoperatively, IOL was always well centered, BCVA was 20/20 and no complications were reported.
Conclusion/Take home message
Transcapsular scleral fixation is an effective, safe and cost-effective alternative to standard scleral/iris fixation techniques in those cases with wide zonular dehiscence at high risk of capsule-IOL luxation. Longer follow-up evaluations are warranted to verify long-term outcomes.