Intraoperative Plan B:Salvage Sutured Scleral Fixation Iol For Failed Sutureless Techniques In Vitrectomized Eye

To report the indications and outcomes of sutured scleral fixation when employed as a salvage procedure for intraoperative failures of various sutureless techniques, including intrascleral haptic fixation and retropupillary iris-claw IOL implantation,in vitrectomized eyes.

Ophthalmology Department, Lamine Dabaghine University Hospital Algiers, Algeria

A retrospective interventional case series was conducted on 6 consecutive vitrectomized eyes. All cases required intraoperative conversion from a failed sutureless technique to sutured scleral fixation using 6-0 polypropylene suture. The primary sutureless techniques and specific reasons for failure were: Intrascleral Haptic Fixation (4 eyes): Aborted due to haptic fracture during externalization (2 eyes) or inability to externalize the haptic (2 eyes). Retropupillary Iris-Claw IOL (2 eyes): Aborted due to inadequate iris stroma for stable enclavation. Outcomes analyzed included procedural success, visual acuity, IOL stability, and postoperative complications throughout the study period.

Conversion to sutured scleral fixation was successful in 100% of cases (6 of 6 eyes).Mean best-corrected visual acuity (BCVA) significantly improved from 1.5 logMAR to 0.2 logMAR at a mean follow-up of 6 months. All IOLs were well-positioned and stable at the last follow-up. Complications included transient hypotony (2 eyes) and mild vitreous hemorrhage (1 eye); all resolved without further intervention. There were no cases of endophthalmitis, retinal detachment, or IOL dislocation.

Sutured scleral fixation is a highly effective and safe salvage technique, ensuring successful IOL implantation and significant visual improvement when primary sutureless techniques fail intraoperatively. Surgeons should be prepared to utilize this reliable 'Plan B' in complex vitrectomized eyes.