• Written By: Lisa B. Arbisser, MD
    Cataract/Anterior Segment

    The authors describe a new surgical technique, Y-fixation, that allows safe intrascleral fixation of a posterior chamber IOL without sutures, glue or complicated intraocular manipulation.

    Everyone is looking for this holy grail to deal with no capsule support. Glue is so expensive, and this is the best scleral fixation I have seen without glue.

    To perform the Y-fixation technique, a Y-shaped incision is made in the sclera and a 24-gauge microvitreoretinal knife is used to create the sclerotomy instead of a needle. The authors note that the Y-shaped incision eliminates the need to raise a large lamellar scleral flap and to use fibrin glue because the haptic can be fixed both inside the tunnel and in the groove, and performing the sclerotomy with the 24-gauge knife simplifies extraction of the haptic and improves wound closure. They say there is no risk of infection from exposure of the haptic on the sclera.

    They also report results of a retrospective nonrandomized interventional clinical study in which the Y-fixation technique was used in 44 eyes of 40 patients and transscleral IOL fixation was performed in 40 eyes of 36 patients at one hospital in Japan from November 2007 to May 2011. No intraoperative complications occurred in the Y-fixation cases. All IOLs were stable and centered at the end of surgery.

    IOL decentration due to ocular contusion was subsequently observed in two eyes but was corrected without difficulty. Visual acuity declined in just one eye with a postoperative retinal detachment. In five eyes with a dislocated IOL, the same IOL was used again.

    There was significantly less IOL decentration and tilt than with suture fixation. Astigmatism was also significantly less marked than with suture fixation, showing virtually no difference from intracapsular fixation. There was no significant difference in the reduction of corneal endothelial cells at six months after surgery between the two groups.

    The authors conclude that their Y-fixation technique is simpler and safer than other intrascleral IOL fixation techniques. They say it is a new-generation secondary IOL implantation method that achieves both anatomical and optical stability, and its further development can be expected.