Secondary Scleral Fixation Of The Sing Imt Using 9-0 Polypropylene Sutures Following Intraoperative Capsular Dehiscence: A Case Report And Comparative Analysis With Gore-Tex Fixation Techniques

To describe a case of secondary scleral fixation of the SING IMT (Smaller-Incision New-Generation Implantable Miniature Telescope) using 9-0 polypropylene (Prolene) sutures following intraoperative capsular dehiscence in a pseudophakic patient, and to compare this technique with previously described Gore-Tex–based scleral fixation approaches.

SING IMT intraocular telescope implantation in pseudophakic patient with a capsular dehiscence

A pseudophakic patient with advanced age-related macular degeneration underwent planned sulcus piggy-bag implantation of the SING IMT. During intraocular telescope insertion, significant capsular dehiscence was observed, resulting in instability of the capsular complex. To ensure adequate centration and long-term stability of the device, an intraoperative decision was made to convert to secondary four-point transscleral fixation using 9-0 polypropylene sutures. The surgical technique, perioperative course, and postoperative outcomes were analyzed. A comparative review of polypropylene versus Gore-Tex scleral fixation techniques was performed based on current literature.

At 10 days BCDVA reached 20/125 (logMAR 0.80), representing a gain of approximately 3 Snellen lines. Distance-corrected near visual acuity improved from non-measurable preoperatively to 0.5 decimal equivalent.

No telescopic IOL tilt, decentration, hypotony, suture erosion, or inflammatory reaction was observed. Endothelial cell loss at 1 months was  less than 9%, consistent with reported values following SING IMT implantation. Intraocular pressure remained stable.

Secondary scleral fixation of the SING IMT using 9-0 polypropylene sutures represents a safe and effective alternative in cases of intraoperative capsular instability. Although Gore-Tex sutures offer superior tensile strength and theoretical long-term durability, polypropylene fixation provides excellent intraoperative handling and secure centration when meticulous technique is applied. Careful long-term surveillance remains warranted due to the known risk of late polypropylene degradation.