This retrospective review evaluated the clinical outcomes and short-term safety profile of scleral-fixated IOLs using Gore-Tex suture and found that patients on average experienced positive visual outcomes with a low rate of adverse events.
Though Gore-Tex is commonly used for heart valve and vascular procedures due to the resiliency of the suture material, ophthalmic surgeons only recently started using Gore-Tex suture off-label with the presumption that it offers a decreased risk of suture breakage. However, its use in ophthalmic surgery has not been well described. This retrospective review, the largest series to date, suggests that surgeons should consider switching from Prolene to Gore-Tex, even though its ophthalmic use remains off-label.
The case series included 85 eyes of 84 patients undergoing ab externo scleral fixation of an Akreos AO60 (Bausch and Lomb) or CZ70BD (Alcon) IOL using Gore-Tex CV-8 sutures. Four separate sclerotomies were made, each 2mm from the limbus. After the suture was passed through the eyelet of the chosen IOL, the ends were passed into the anterior chamber through a main incision and externalized through one of the sclerotomy sites. After IOL insertion, the sutures were tightened, IOL centered and knots trimmed and rotated into a sclerotomy.
In this surgical video, Dr. Jason Hsu demonstrates how Gore-Tex sutures can offer a stable 4-point IOL fixation.
Mean follow-up, which ranged widely from 90 to 996 days, was 325 days. LogMAR visual acuity significantly improved from 1.43 to 0.64 (P<0.001). No intraoperative complications were noted. The most common postop complication was temporary hypotony (9.4%), which resolved on its own by 1 month. Encouragingly, there were also no cases of postoperative endophthalmitis, suture erosion/breakage, retinal detachment, suprachoroidal hemorrhage, uveitis–glaucoma–hyphema syndrome or persistent postoperative inflammation.
In addition to its strength, Gore-Tex suture has several advantages over Prolene: it’s more visible, induces minimal inflammatory response and has minimal memory, making it exceptionally easy to manipulate. While promising, the authors conclude that further long-term, prospective, comparative trials will be necessary to determine superiority of this technique compared with alternative IOL implantation strategies.
