Outcomes Of Pars Plana Vitrectomy And 4-Point Gore-Tex Sutured Scleral Fixation Of Micropure Intraocular Lens: A Case Series

To evaluate clinical outcomes in terms of best-corrected visual acuity (BCVA), IOLs transparency, stability, and patient satisfaction using a novel modification of the standard 4-point scleral fixation technique using Gore-Tex CV-8 sutures and a hydrophobic intraocular lens (IOL) in eyes lacking sufficient capsular or iridial support for IOL placement.

We introduce a modification of this scleral-fixated intraocular lens (SFIOL) technique originally described by Khan et al. The Micropure lens was chosen due to its four-point support design, hydrophobic acrylic material, and low incidence of opacification. A case series is presented, in which this technique was consistently performed by the same surgeon.

Department of Ophthalmology, Mútua Terrassa University Hospital, Terrassa, Barcelona, Spain. Department of Ophthalmology, Centro de Oftalmología Barraquer. Barcelona, Spain

Case 1: A 65-year-old (yo) woman with opacification of a piggy-back IOL and a large posterior capsulotomy presented with a BCVA of 0.2 in the right eye (RE). Due to the extreme power of the IOL, no suitable iris-fixated IOL was available. The patient ultimately underwent explantation of the opaque IOL, followed by scleral fixation of a Micropure lens.

Case 2: A 33 yo male patient with traumatic aniridia, aphakia and corneal leukoma in the RE. After trauma, he required retinal detachment surgery. BCVA was 0.05. A combined procedure of penetrating keratoplasty (PK) and sutured SFIOL-artificial iris complex was performed.

Case 3: A 73 yo woman with traumatic brunescent cataract and iridodialysis in the RE. Remnants of iris persisted inferiorly, but the rest was disinserted. BCVA was 0.9 in RE. An extracapsular cataract extraction and sutured SFIOL-artificial iris complex were performed.

Case 4: 81 yo woman with a history in the RE of a decompensated DSAEK, pupillary dyscoria and subluxation of the IOL into the vitreous cavity after a complicated cataract surgery two years ago. BCVA was 0.06. The patient underwent PK following a complete pars plana vitrectomy, explantation of the subluxated IOL, and implantation of a Micropure IOL sutured to the sulcus using a four-point fixation technique.

All surgeries were successful and postoperative evolution was satisfactory with no observed IOL tilt or loss of IOL transparency. BCVA improved in all four cases and remained stable over time.

The modified 4-point Gore-Tex SFIOL represents an alternative to classic sutureless fixation methods. It optimizes preoperative biometric calculations by offering greater predictability of the final IOL position and improved stability compared to two-point scleral fixation by reducing tilt and decentration rates. Gore-Tex CV-8 sutures provides significant advantages over polypropylene, including lower long-term degradation, minimal inflammatory response, and reduced risk of conjunctival erosion due to buried sutures. Hydrophobic IOLs exhibit lower opacification rates than hydrophilic ones. Based on postoperative BCVA outcomes, we consider this a viable and effective option for patients with insufficient capsular or iridian support.