Novel Approach to Scleral Refixation of a Single Dislocated Haptic of a Scleral-Fixated IOL
Narrative Responses:
Purpose
To present a unique technique for refixating a single dislocated haptic of a previously scleral-fixated intraocular lens (IOL). The haptics of this IOL did not have suture-fixation islets.
Methods
Case Report. An 87 year old Caucasian male presented with a dislocated IOL secondary to a single dislocated haptic. 2 years prior, the patient had undergone scleral-suture-fixation of the IOL-capsular bag complex due to IOL subluxation secondary to pseudoexfoliation. During subsequent pars plana vitrectomy surgery, in attempts to clean up some capsular bag and cataract remnants, the retinal surgeon inadvertently cut one of the 9-0 prolene scleral-fixation sutures. The next day, the intraocular lens was dislocated.
Results
The dislocated IOL was re-fixated to the sclera. 9-0 prolene suture was tied securely around the PMMA haptic. The needle at the other end of the suture was then passed through the sclera via an ab interno approach. Externally, the needle was passed through the superficial sclera via a scleral flap double-pass method. The suture was tied to itself and secured to the sclera. The scleral flap was closed with vicryl suture, covering the prolene knot. Images shown.
Conclusion
A previously scleral-fixated IOL with a single dislocated haptic without an islet may be successfully re-fixated in a secure fashion by the technique described. Future haptic slippage is highly unlikely with this technique. IOL exchange utilizing an IOL with islets incorporated into the haptics is not necessary.