Transscleral suture fixation of a posterior chamber intraocular lens (IOL) is an operation performed on eyes without adequate capsular support. Polypropylene sutures have been used to fixate IOLs for decades. Although their material is non‑biodegradable, the rate of IOL subluxation or dislocation due to suture breakage or erosion ranges from 1.3% to 27.9%. However, due to the limitations of the learning curve of surgical equipment and surgical techniques, dislocated single‑piece rigid polymethylmethacrylate (PMMA) IOLs with small eyelets in the haptics present unique challenges. Here, we propose a modified procedure for internal refixation of subluxated PMMA IOLs with less surgical trauma.
The aim of this study was to describe a modified technique for internal refixation of dislocated scleral‑sutured polymethylmethacrylate (PMMA) intraocular lenses (IOLs) with eyelets. Three‑port pars plana vitrectomy was performed. Through the scleral fixation site, a 30‑gauge needle loaded with an 8‑0 polypropylene suture was inserted into the vitreous cavity. The suture end was passed through the eyelet of IOL with 25‑gauge forceps. Next, it was guided out of the eye through the original scleral fixation point. The end of the exterior suture was buried with a flapless intrascleral knotting technique. Six eyes of six patients were successfully treated with this technique and followed up for 6–12 months postsurgery. In all cases, there was significant improvement in uncorrected visual acuity. IOLs were stable with proper centration and no major complications.
Management of dislocated IOLs is a challenging surgical problem. Several management techniques have been reported, including IOL exchange and refixation. Compared to IOL replacement, IOL refixation is preferred because it avoids large corneal/scleral incisions and causes less surgical trauma in a closed‑eye system.
In this study, authors successfully achieved transscleral suture refixation of PMMA IOLs with eyelets using 25‑gauge vitreoretinal forceps and 30‑gauge needles commonly used in vitreoretinal surgery. This modified technique can reduce trauma because neither haptic externalization nor scleral flap is necessary. It allows for easy IOL fixation by suturing through the IOL eyelet using a bimanual approach.
In the study, the satisfactory outcome of this technique demonstrates its efficacy and safety in treating dislocation of scleral‑sutured PMMA IOLs. CZ70BD and black diaphragm were used for a scleral‑sutured, nonfoldable PMMA IOL that has an overall tip‑to‑tip size of 12.5 or 13.5 mm. In addition, this technique minimizes surgical trauma to the intraocular tissue which is caused by adverse contact with the hard IOL. All manipulations are performed with the IOL in the anterior vitreous cavity, which is a relatively spacious and safe place for a variety of surgical procedures.
In conclusion, dislocated PMMA IOLs with eyelets can be safely managed with our technique, which is minimally invasive and provides great benefits. This study was limited by the small sample size because IOL dislocation occurs infrequently. Studies covering more cases with a longer follow‑up time are needed to assess other possible complications.
Source: Gao Y, Xing X, Zheng K, Wan L. Modified technique for repositioning dislocated polymethylmethacrylate intraocular lenses with eyelets. Indian J Ophthalmol 2024;72:1064-7.
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