Intraocular lens fixation: updating surgical techniques

1
Intraocular lens fixation updating surgical
techniques

• Fabio H Casanova, MD PhD1
• Lincoln L Freitas, MD PhD1
• 1 Federal University of São Paulo, Paulista
  School of Medicine, São Paulo, Brazil.

The authors have no financial support
2
Purpose

• To present an update on intraocular lens (IOL)
  fixation techniques used for secondary IOL
  implant or IOL reposition, as well as a new
  approach following lens subluxation.

3
Methods

• Surgical options
• AC IOL or Artisan lens for aphakia
• Iris- and scleral-fixated IOL techniques
• For lens subluxation, two new approaches for
  scleral fixation with foldable IOL in-the-bag
  using regular capsular tension ring (CTR) or
  directly to the haptic of the IOL
• With no capsular bag new device (artificial
  capsular bag)

4
Results

• Surgical options
• AC IOL or Artisan lens for aphakia

5
Results

• Surgical options
• Iris- and scleral-fixated IOL techniques

6
Results

• Surgical options
• For lens subluxation, two new approaches for
  scleral fixation with foldable IOL in-the-bag
  using regular capsular tension ring (CTR) or
  directly to the haptic of the IOL (close to its
  insertion at the optic)

7
Results

• Surgical options
• For late IOL subluxation, the capsular bag can be
  transfixed and sutured to the sclera

8
Results

• Surgical options
• With no capsular bag new device (artificial
  capsular bag)

9
Results

• Lens subluxation group
• Ten patients underwent these new techniques for
  IOL-capsular bag fixation. No capsular bag damage
  was noted.
• Postoperative IOL centration was obtained in all
  cases.
• Mean follow-up was 18 4.5 months.

10
Conclusion

• Modified suture to CTR or IOL haptic fixation may
  simulate the Cionnis ring type 1 or 2. Minimally
  invasive approach is observed.
• An artificial capsular bag can be an alternative
  for IOL implant in aphakia
• Despite challenging cases, proper surgical
  approach using two-hand technique, iris hooks for
  stabilization and maintenance of the capsular
  bag, and in-the-bag foldable IOL implantation
  with CTR or IOL haptic scleral fixation resulted
  in fewer complications and better final visual
  outcomes.