Belt Loop Technique For Scleral Fixation

To evaluate clinical outcomes in terms of best-corrected visual acuity (BCVA), IOLs centration, stability, and patient satisfaction using belt loop technique of scleral fixation of intraocular lens (IOL) with IOL dislocation in the bag, where capsule fibrosis around the haptics provides additional support for the suspension of the belt loop. This approach was first described by the late Alan Crandall, MD. A case series is presented, in which this technique was consistently performed by the same surgeon.

Department of Ophthalmology, Tomas Bata Regional Hospital, Czech Republic

Case 1: A 73-year-old (yo) man with about a month of impaired vision in the left eye due to subluxation of the intraocular lens presented with a BCVA of 0.4 in the right eye (RE). Cataract surgery was performed 4 years ago in another department, he had a wooden injury to the left eye and then he underwent traumatic cataract surgery with intraoperative ring implantation.Case 2: A 84 yo female patient who cannot see during the day in her right eye due to complete dislocation of the intraocular lens into the vitreous space. The patient underwent cataract surgery in her right eye in 2012 with intraocular ring implantation. BCVA was 0.63. Case 3: A 76 yo man with approximately 14 days of impaired vision in the left eye due to a dislocated IOL in the left eye, denies injury. BCVA was 0.32. The left eye underwent cataract surgery in 2000 at another department, the left eye is amblyopic, and the left eye has pellucid marginal degeneration. The plan during hospitalization is a 25-gauge (25G) pars plana vitrectomy (PPV), anterior vitrectomy, explantation of the IOL intraocular lens using the twist and out technique, and finally belt loop scleral fixation of the toric IOL. 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.

• In all cases, intraocular lens (IOL) centration was achieved by scleral fixation using our chosen belt loop technique, improving vision and subjective patient satisfaction. The belt loop technique of scleral fixation appears to be an effective and gentle method that is suitable for any type of intraocular lens (IOL) with IOL dislocation in the bag, where capsule fibrosis around the haptics provides additional support for the suspension of the belt loop. It is important that the IOL is correctly positioned in the bag. The advantage of this method is that it is minimally invasive and causes only minor disruption of the conjunctiva, but the experience and skill of the surgeon performing this technique are required.