Scleral fixation of dislocated single piece foldable Acrysof IOL without delivering the entire IOL o

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Scleral fixation of dislocated single - piece
foldable Acrysof IOL without delivering the
entire IOL out of the eye

• Dr. Suven Bhattacharjee, MS, DO, DNB.
• Dr. Abhijit Ghosh, MS.
• Dr. Arup Chakrabarti, MS.

COMPLETE CARE Kolkata, INDIA suvenb_at_gmail.com
No Financial Interest
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Disclosures

• The author co-authors have no proprietary or
  financial interest in the devices used the
  techniques mentioned in this paper.
• Scleral fixation of a Single Piece Acrysof IOL is
  an Off - Label use of the device.

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Purpose

• To demonstrate a technique of scleral fixation of
  dislocated / subluxated Single Piece (SP)
  foldable Acrysof IOL
• By delivering only the haptics and not the entire
  IOL out of the eye
• Using side port incisions only without reopening
  / enlarging the original Phaco wound
• Without IOL explantation - reimplantation /
  exchange eliminating associated trauma to the
  eye and the IOL optic
• Taking advantage of the material design of the
  Single Piece (SP) foldable Acrysof IOL.

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Methods - Inclusion criteria

• Eyes that have undergone Phaco with SP Acrysof
  IOL implantation
• Subluxated / Dislocated single piece Acrysof IOL
  lying in anterior vitreous
• Lack of any capsular support No possibility of
  sulcus placement without transscleral fixation
• Attached retina

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Methods - Technique
Watch Video in Additional Files

• SP Acrysof IOL manipulated into AC bimanually
  through side port incisions
• Ant Vitrectomy through side port
• 10-0 Polypropylene suture on Straight needle
  passed 1.5 mm behind limbus under scleral
  flap and railroaded out thru opposite side port
  incision using 26G needle
• Straight needle backtracked to exit through
  sclera under flap 2 mm adjacent to point of entry
• Haptic suture loop exteriorized through side
  port
• Knobbed Haptic passed thought Cow hitch knot
• Suture tightened and knotted, scleral flap
  reposited

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Methods Cow hitch knot
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Methods - Technique
Watch Video in Additional Files
Bring IOL into AC
Straight needle prolene suture
Backtrack needle to make loop
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Methods - Technique
Watch Video in Additional Files
Exteriorize haptic
Exteriorize Suture loop
Haptic through Cow hitch knot
Tighten suture
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Results

• Dislocated / subluxated SP Acrysof IOL 3 eyes
• Mean age 56 years
• Disturbed anterior vitreous at presentation 3
  eyes
• Operative Complication 1 eye
• (hyphema from the AC Angle while introducing the
  straight needle - controlled by raising the IOP)
• Post Op complication 1 eye
• (CME 2 weeks post op - resolved within 3 months)
• All 3 eyes had a stable, secure well centered
  PC IOL in the 6 months post operative follow up
  period
• All eyes had best corrected visual acuity of
  20/20 at 6 months follow up.

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Results
Prolene suture under scleral flap
Edge of Acrysof SP IOL seen only on dilatation No
capsulorhexis egde or PC visualized
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Conclusions
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• A dislocated or subluxated SP Acrysof IOL can be
  fixated to the sclera by exteriorizing the
  haptics through side port incisions, without
  removing the entire IOL out of the eye or
  reopening / enlarging the Phaco wound.
• The technique is safe, fixates the IOL securely
  retains all the advantages of a closed chamber
  small incision surgery.
• Cow hitch knot eliminates the possibility of
  cut suture ends rubbing against ciliary sulcus

Contd..
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Conclusions
Watch Video in Additional Files

• The Single piece Acrysof foldable IOL design and
• material presents unique advantages in this
  technique

• Haptic - Optic junction
  Permits greater flexibility
• Stableforce haptic design
  Permits greater haptic deformity
• Knobbed tip hydrophobic foldable acrylic
  material of haptic Prevents Cow hitch
  knot from slipping
• Eyelets in haptics not required