Prevention of suture knot exposure in posterior chamber intraocular lens implantation by 4-point scleral fixation technique.

Department of Ophthalmology Uludag University School of Medicine, Bursa, Turkey.
Ophthalmic Surgery Lasers and Imaging (Impact Factor: 1.46). 01/2004; 35(5):379-82.
Source: PubMed

ABSTRACT The results and complications of posterior chamber intraocular lens (IOL) implantation by a 4-point scleral fixation technique are described.
Fifty eyes of 47 patients who underwent scleral-fixated IOL implantation were retrospectively evaluated. Twenty-one (42%) eyes had a history of trauma and 29 (58%) eyes had previously undergone cataract surgery. In all cases, IOL implantation by 4-point scleral fixation was performed and the knots of fixation sutures were rotated and buried in the globe. The IOL position was adjusted by suture rotation for best centration.
The mean follow-up time was 7 +/- 4 months. Four (8%) eyes had minimal corneal edema preoperatively. Cystoid macular edema was noted in 2 (6.8%) eyes in the cataract surgery group and 8 (38%) eyes in the posttraumatic group. Two (9.5%) eyes in the posttraumatic group had atrophic macular changes and 1 (4.7%) had corneal scarring, which impaired vision. No complications such as knot exposure, tilting of the IOL, decentralization, or endophthalmitis were noted postoperatively. Postoperative mean corrected visual acuity was 0.4 +/- 0.3 in the posttraumatic group and 0.4 +/- 0.2 in the cataract surgery group.
The 4-point scleral fixation technique resulted in no serious postoperative complications such as suture exposure and endophthalmitis. Because the knot can be rotated and buried in the globe, knot exposure is less likely to occur. This procedure is more effective than other techniques regarding IOL centralization.

  • [Show abstract] [Hide abstract]
    ABSTRACT: To report long-term visual outcomes and complications of a new foldable, one-piece, acrylic posterior chamber intraocular lens with closed-loop haptics (C-flex, Rayner, UK) for scleral fixation. Retrospective interventional case series of 29 eyes of 29 patients who underwent scleral fixation with the C-flex intraocular lens in the absence of capsular support. Review of 29 consecutive cases from January 2001 to December 2005 in which scleral fixation was performed with the C-flex intraocular lens. All cases were performed by a single surgeon (S.J.L.) and with an ab externo two-point scleral fixation technique. Preoperative status, intraoperative complications, and postoperative outcomes were analyzed. Mean best corrected visual acuity improved from 20/150 to 20/40 (P < 0.001) at 1 month and to 20/50 (P < 0.001) at mean follow-up of 41 months. Complications included clinically insignificant decentration [1 (3%)], mild intraoperative vitreous hemorrhage [1 (3%)], postoperative hyphema [2 (7%)], and transient elevated intraocular pressure [2 (7%)]. All complications were mild and resolved without the need for reoperation. Scleral fixation of the closed-loop, foldable, acrylic C-flex intraocular lens appeared to reduce operative time, was associated with minimal postoperative complications, and resulted in long-term visual improvement.
    Retina (Philadelphia, Pa.) 10/2008; 29(1):91-7. · 2.93 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the long-term results of transsclerally fixated posterior chamber intraocular lenses (SF-PCIOLs) in children without adequate capsular support. Noncomparative interventional case series. Twenty-five eyes of 23 children who underwent primary (6 eyes) or secondary (19 eyes) implantation of SF-PCIOLs. The primary cases included those undergoing surgery for lens subluxation due to Marfan's syndrome, and secondary cases included those after surgery for congenital cataract (3 eyes) or traumatic cataract (16 eyes). All eyes lacked adequate capsular support and, in secondary cases, manifested contact lens intolerance. Ab externo transscleral fixation of PCIOLs. Visual acuity (VA), IOL position, and postoperative complications. The mean age of patients at the time of SF-PCIOL implantation was 79+/-20.2 months (range, 33-120). The mean duration of follow-up after surgery was 81.1+/-46.2 months (range, 12-144). Best-corrected VA improved postoperatively in 12 eyes (48%) by >1 Snellen line. The main cause of reduced vision was corneal and retinal pathologies and amblyopia. Complications included transient intraocular hemorrhage in 13 eyes (52%), transient choroidal effusion in 2 eyes (8%), late endophthalmitis in 1 eye (4%), retinal detachment in 1 eye (4%), and late IOL dislocation due to breakage of polypropylene sutures after 7 to 10 years in 6 eyes (24%). Scleral fixation of PCIOLs can be visually rewarding in selected cases, but there is a high rate of complications during a long-term follow-up.
    Ophthalmology 02/2008; 115(1):67-72. · 5.56 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The presented Z-suture is a simple, rapid and safe knotless technique that facilitates transscleral suture fixation of various intraocular implants in the ciliary sulcus, such as sutured intraocular lenses, artificial iris prostheses and iris diaphragms. As the knotless approach reliably avoids suture erosion, external fixation can be performed without any protecting scleral flaps or lamellar grooves. The needle is simply passed through the sulcus and the emerging polypropylene suture is secured in the sclera using a zigzag-shaped intrascleral suture (Z-suture). Each pass starts directly adjacent to the exiting site. Five passes are sufficient to reliably fix the suture so that it resists even maximum tractive forces. Once this procedure is done, the suture can be cut without any knot. By avoiding suture knots, and hence the need for intrascleral flaps, this knotless approach may help to reduce suture-related complications such as scleral atrophy, suture erosion and infections.
    The British journal of ophthalmology 02/2010; 94(2):167-9. · 2.92 Impact Factor