Fighting For The Bag: Visual Outcomes Of Capsular Bag Scleral Fixation With Ahmed Segment And Flanges In Patients With Zonular Weakness—A Retrospective Case Series

For the past few decades, in-the-bag intraocular lens (IOL) implantation has been the standard of care in cataract surgery. However, achieving this goal is more challenging in patients with significant zonular weakness. To address this challenge and preserve the anatomical structure of the capsular bag, we employed a novel surgical technique of scleral fixation of the bag using Ahmed segments with flanges.

We report the surgical technique and the visual outcomes of capsular bag scleral fixation using Ahmed segments and flanges in patients with severe zonular weakness.

Retrospective case series.

Patients with zonular weakness who underwent cataract surgery and had the capsular bag fixated to the sclera using an Ahmed segment with flanges, in addition to capsular tension ring implantation, were included. Medical records were reviewed, and pre- and postoperative data were collected. One or two Ahmed segments were used, fixated to the sclera with 6-0 polypropylene sutures, positioned 1.5 mm from the limbus. The primary outcome was postoperative uncorrected visual acuity. Secondary outcomes included corrected visual acuity, refractive outcomes, IOL position, and postoperative complications.

Twenty-one eyes of twenty patients were included in the study, with a mean age of 75 years and 57% male participants. In fourteen (67%) eyes, zonular weakness was secondary to pseudoexfoliation syndrome. Ocular trauma was the second most common cause (10%). The average follow-up period was 228 days. At the final follow-up, all IOLs were centered and showed no significant tilt. The mean uncorrected visual acuity was 20/50, and the mean spherical equivalent was -0.69D. One patient experienced toxic anterior segment syndrome, one patient developed cystoid macular edema, and two patients experienced a deterioration of pre-existing glaucoma following surgery.

Capsular bag fixation using Ahmed segments and flanges is an effective and feasible technique, even in complex cases. It ensures the stability of both the capsular bag and the IOL, allowing patients to achieve the best possible visual acuity under challenging circumstances.