Needle-Assisted Intrascleral Fixation of 3-Piece Posterior Chamber IOL for Aphakic Correction
Narrative Responses:
Purpose
We describe a new technique for the surgical correction of aphakia that permits intrascleral fixation of a three piece posterior chamber intraocular lens (IOL) without sutures. The technique is useful in cases where capsule support is not adequate for placement of secondary IOL. The haptic is externalized with a bent 26-gauge needle. The technique is particularly appropriate for 3-piece IOLs with flexible haptics.
Methods
Under peribulbar anesthesia, after conjunctival peritomy and cautery of the scleral bed, a 3.0 mm X 3.0 mm partial-thickness scleral flaps are made 180 degrees apart at 9 o’clock and 3 o’clock position. Two sclerotomies are made 1.5 mm away from the limbus on the base on the base of scleral beds. The proceeding haptic of 3-piece IOL is inserted into the anterior chamber through superior corneoscleral tunnel with a Mcferson ‘forceps. The haptic is docked in the tip of the bent 26-G needle introduced through sclerotomy at 9 o’clock and same procedure is then repeated for the other haptic at the 3 o’clock position. Both haptics are buried in scleral tunnel parallel to limbus and scleral flaps and conjunctiva is sutured.
Results
Five eyes of 5 aphakic patients were operated by a single surgeon using above mentioned technique. No Intraoperative complication was noticed. At six weeks follow-up, 3 patients had Best corrected visual acuity (BCVA) of 6/9 and 2 patients have BCVA of 6/18 and 6/36 respectively due to underlying macular pathology.
Conclusion
The needle-assisted intrascleral fixation of posterior chamber intraocular lens for aphakic correction is safe and effective procedure for scleral positioning of haptics of three piece IOL in cases with insufficient capsular remnants. This technique does not require the use of instrumentation other than that required for routine cataract surgery.