Trochar-Assisted Transconjunctival Sutureless Intrascleral Fixation Of A Artificial Iris With An Intraocular Lens

I describe a technique for sutureless intrascleral fixation of a 3-piece intraocular lens (IOL) and artificial iris implant complex to provide the optical and functional issues of aphakia and aniridia, as well as to obtain excellent cosmetic results.

A new method

Two scleral tunnels were created 2 mm away from and parallel to the limbus using 25-gauge vitrectomy trocars that entered the sclera transconjunctivally at the 3 O’clock and 9 O’clock meridians at an angle of approximately 10°. After a localized conjunctival peritomy is performed, a 7.0 mm scleral tunnel incision is made to insert the IOL–iris prosthesis complex. The 3-piece IOL is anchored to the iris implant using the belt-loop technique. A 45-degree slit blade makes the belt loop consisting of 2 parallel slits in the mid periphery of the artificial iris. This IOL–iris prosthesis complex was implanted into the AC with forceps through the scleral tunnel incision. The tip of one of the IOL haptics was grasped with a 25-gauge serrated retinal forceps and entered through one of the trocar’s cannula, and the haptic and the 23-gauge cannula were together pulled out from the scleral tunnel simultaneously. A transconjunctival safety 10-0 nylon suture, which was removed at the end of the first postoperative week, was placed at the scleral tunnel entry. The end of the haptic was cauterized to make a flange. Similar maneuvers were applied for the other haptic. Then scleral tunnel incision was closed with an 8/0 vycril suture and the conjunctival peritomiy was closed with a 10/0 nylon suture.

Intrascleral haptic fixation is a stronger fixation method in patients with aphakia and aniridia.