Intraocular lens reposition using sclerocorneal fixation technique
First Author: A.Kozhukhov RUSSIA
Co Author(s): O. Unguryanov T. Dinh
There are various methods to treat complicated pseudophakia, depending on the IOL model and its location in the eye: IOL replacement, fixation to the iris, implantation into the ciliary sulcus, and fixation to the sclera. Each of these methods has its advantages and disadvantages. However, IOL scleral fixation technique with or without using suture knot possesses the biggest advantages. Nevertheless, the search for a new effective method of IOL fixation for non-standard surgical situations, which eliminates the above mentioned disadvantages, is relevant. Purpose: to study and compare the results of knot and knotless ''sclerocorneal'' fixation technique of intraocular lens
Private Eye clinic : ''Spectr'' Moscow Berezovoy Roshchi Proyezd, 12, Moscow, 125252
50 patients underwent surgery according to IOL ''sclerocorneal'' fixation technique, developed by us.37 patients had partial IOL dislocation,while 13 patients had in-the-bag IOL dislocation(into vitreous body).VA before operation: 0,05-0,2 sc, VA: 0,5-1,0 (with aphakic correction depending on concomitant pathology).In 34 cases knots were formed at the end of the thread, which were immersed in corneal paracentesis, in 16 cases, we performed knotless flanged technique.For flanged technique the cauter is used to coagulate the suture end till the very end to the fixating instrument. The suture is buried in a similar fashion.
1 week postoperatively (p/o)VA reached 0,2-1,0 sc, and VA: 0,3-1,0 cc(with correction). 32 eyes had myopia: from -0,5D up to -2,25 D.; 7 eyes- had emmetropia; 9 eyes had astigmatism: up to -1,5 D; and 4 eyes had hypermetropia up to +0,75 D. IOP after surgery : 15- 20 mm.Hg. in 42 patients. Follow up period - 5 years. In 48 cases IOL central stable fixation was achieved. In 2 cases decentration of 0,5 mm and 0,75 mm occured, however it didn't affect the p/o visual acuity. In 2 more cases,tilt of IOL was detected and measured - 0,3mm and 0,5 mm. The position of the suture is not undergoing protrusion through the cornea in any direction and the avascular corneal tissue induces a minimal biodegradation influence on the suture.The corneolimbal area surves as a secure suture depot with the durable resistance that allow to fixate the suture ends and provide a long-term visualization of the exact position of the suture ends.
1)The new method of ''Sclerocorneal '' fixation of IOL(with suture ends located in transparent corneal paracentesis) is low-traumatic, reduces scleral/conjuctival trauma, and exclude suture ends erosion. 2)The results of the''Sclerocorneal ''fixation technique of IOL are equally good regardless of the use of suture knot for stable fixation of the suture end in the corneal incision or the use of flanged technique. 3)The developed surgical technique for ''Sclerocorneal' IOL fixation leads to rapid visual rehabilitation due to the use of small incisions and the absence of sutures that require subsequent p/o removal. In addition it allows to preserve the pupillary function.