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  • Scleral fixation using Gore-Tex suture of a subluxated PCIOL

Scleral fixation using Gore-Tex suture of a subluxated PCIOL
Reviewed by Sofia Rokerya

30 June 2025 | Sofia Rokerya | EYE - Cataract, EYE - Refractive
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This was a retrospective single-centre study of patients who underwent lasso in-the-bag scleral fixation of a subluxated posterior chamber (PC) intraocular lens (IOL) using the snare technique with Gore-Tex suture from 2019 to 2021. Functional outcome was analysed by clinical assessment, and anatomical outcome, by ultrasound biomicroscopy (UBM) – a portable and manoeuvrable biomicroscope used intraoperatively. Eighteen eyes of 18 patients were included in the study. The mean duration of follow-up was 140 days (range 23–659), and the median time from PCIOL implantation to fixation was 8.5 years (IQR 6.25–10.75). All patients had ocular comorbidities, mainly glaucoma (n=6) and pseudoexfoliation syndrome (n=5). Best corrected visual acuity (BCVA) improved from a median of 6/30 (0.7logMAR) to a median of 6/12 (0.35logMAR) (p=0.06); postoperative astigmatism measured 0.91 ±2.19 dioptres. Ultrasound biomicroscopy demonstrated well-balanced PCIOL fixation with no difference between the horizontal and vertical tilt measurements (p=0.84; p=0.94; p=0.62; p=0.085). The fixated PCIOL showed <10% decentration with reference to the visual axis. There was a high negative correlation between BCVA improvement and residual lens tilt (r=-0.76, p=0.037). Postoperative complications included transient ocular hypertension (n=3), corneal decompensation with subsequent keratoplasty (n=3), temporary hypotony (n=2), cystoid macular oedema (n=1), suture the exposure (n=1), and endophthalmitis (n=1). The study concluded that minimally invasive lasso-snare technique using Gore-Tex suture in patients with a subluxated PCIOL yielded very good anatomical results in terms of lens tilt and centration. Image analysis with UBM may serve as an important tool to facilitate localisation of the fixated PCIOLs. Limitations: Retrospective design, small sample size and performance bias (complicated procedures were performed by two surgeons in complicated cases; therefore, these postoperative outcomes might not be comparable to procedures performed by less experienced surgeons). Also, preoperative spherical equivalent and astigmatism values were not available owing to the unpredictable nature of PCIOL subluxation and due to patients’ variable BCVA, there was limited ability to correctly assess refraction.

Ultrasound biomicroscopy in scleral fixation using Gore-Tex suture of a subluxated posterior chamber intraocular lens.
Tiosanoa A, Sellaa R, Gal-Or O, et al.
OPHTHALMOLOGICA
DOI:10.1159/000543255. ePub ahead of print.
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Sofia Rokerya
CONTRIBUTOR
Sofia Rokerya

MBBS MRCOphth FRCSI, King's College University Hospital, UK.

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