Scleral fixation suture technique without lens removal for posteriorly dislocated intraocular lenses.

BACKGROUND

Posterior chamber intraocular lenses (IOLs) may dislocate into the vitreous or over the retina at the time of, or several months after, surgery or following injury. Techniques described to reposition dislocated lenses have drawbacks, such as lens removal, lens exchange, difficulties of lens repositioning procedures and high cost We describe a technique in which the haptics of dislocated IOLs are fixed to the sclera after the haptics are externalized solely through a pars plicata incision site and tied with a 10-0 Prolene suture.

METHODS

After pars plana vitrectomy, the IOL was grasped with an intraocular forceps and moved to the pupillary area. A second intraocular forceps was inserted from the site of planned fixation, and the tip of the haptic was pulled out and heated to form a knob to avoid suture slipping. A 10-0 Prolene suture was then tied to the haptic by means of a sailor knot The haptic was reinserted intraocularly, and the outstaying sutures were tied with conventional knots over the sclera or under the scleral flaps. The procedure was then repeated on the other side.

RESULTS

This technique has been used in 12 patients (12 eyes), 7 men and 5 women ranging in age from 45 to 77 (mean 63.8 [standard deviation 8.5]) years. The time between diagnosis of dislocation and surgery was 10 to 20 days in six cases and 21 to 39 days in six cases. The IOL was dislocated into the vitreous in eight cases (67%) and over the retina in four cases (33%). The preoperative best corrected visual acuity ranged from 20/200 to 20/30. Intraoperatively, mild vitreous hemorrhage developed in two patients (17%), macular edema developed in two patients (17%), and rhegmatogenous retinal detachment developed in one patient (8%). The final visual acuity ranged from 20/50 to 20/20 in 11 patients; the patient with retinal detachment had hand movement vision.

INTERPRETATION

The technique of scleral fixation of posteriorly dislocated IOLS without lens removal is a safe, inexpensive and useful complement to other techniques.