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  • Simple Scleral IOL Fixation Without Glue or Sutures

    By Lynda Seminara
    Selected By: Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, August 2020

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    Although ideal placement for an IOL is within the capsular bag, this may not be possible in difficult cataract cases. Scleral-fixated IOLs (SFIOLs) are an alternative in such situations, and their risk of corneal endothelial damage, adhesions, and glaucoma are lower than for anterior chamber or iris-claw lenses. Boral and Agarwal assessed the effectiveness of a modified SFIOL in cataract surgery. The SFIOL significantly improved patients’ vision and did not require any complicated instruments or scleral-fixation tools.

    This retrospective study included 81 eyes (73 patients) with post-op follow-up of at least six months. The procedures were performed by a single surgeon during a four-year period and involved the following steps:

    • Two diagonally opposed paralimbal curved self-sealing pockets were created 3 mm from the limbus. During surgery, patients underwent sutureless vitrecto­my and sclerotomy.
    • An acrylic multipiece foldable IOL was used for scleral fixation. The exter­nal haptics were placed inside a linear scleral tunnel that was created under the superficial scleral flap of the scleral pockets.
    • Forceps were used to place the haptics in this tunnel, and the IOL was positioned properly. The haptics stayed in place without suture or glue because the scleral fibers held them in the linear scleral tunnel. Cautery was used to replace the conjunctival flap.
    • All patients received topical steroids postoperatively. Haptic positioning and optic tilt were assessed by optical coherence tomography of the anterior segment and ultrasound biomicroscopy.

    This simplified SFIOL approach significantly improved best-corrected visual acuity from pre-op values, without any major complications. (Two cases of haptic slippage into the vitre­ous cavity occurred; these were fixed in a new scleral tunnel.) Moreover, the lenses maintained stability and optimal placement. These findings echo those of previous SFIOL investigations, and the authors encourage multicenter pro­spective studies to evaluate long-term outcomes.

    The original article can be found here.