“The Dumbbell Technique” – Four Flanged Foldable Intraocular Lens Intrascleral Fixation

To report on a novel method of intrascleral fixation of one piece foldable intraocular lens (IOL) - “the dumbbell technique”.

A prospective, noncomparative, interventional case series of patients who underwent four-flanged intrascleral one piece foldable IOL fixation - “the dumbbell technique” in Grantham Hospital, Hong Kong SAR.

In this dumbbell technique, a one piece foldable IOL is fixated to the scleral with a flange above and below each haptic like a dumbbell.

A 6-O polypropylene suture with needle end is passed through the end of a foldable IOL haptic. The suture needle is then cut and the cut end is heated to create the first flange. Same procedure is repeated on the other haptic to create the second flange. The free suture ends are passed through a 2.75mm main wound into the eye and externalized 2mm post limbus 180 degree away from each other. The foldable IOL is then inserted into the eye with folding forceps and centred by pulling onto the externalized sutures. Externalized sutures are trimmed and flanged ends are created and buried under conjunctiva.

5 eyes from 5 patients were included in our study. All patients were aphakic from previous complicated cataract surgeries. The mean visual acuity improved from 1.84 logarithm of the minimum angle of resolution (logMAR) units preoperatively to 0.15 logMAR postoperatively with a mean follow up period of 29.2 months. There were no incidents of postoperative endophthalmitis or IOL dislocation or other postoperative complications.

“The dumbbell technique” is a potentially safe, relatively simple and effective way to perform intrascleral IOL fixation in patients with inadequate capsular support. As the foldable lens can fit into a small cornea wound incision, risk of astigmatism can be minimized. Less manipulation is required intraocularly with this procedure, hence minimizing risks of endothelial injury or haptic damage. There is also lower risk of suture breakage which may lead to IOL dislocation as no knots are necessary.