The authors report on a prospective, non-comparative, interventional case series of patients undergoing sutureless intrascleral fixation of a posterior chamber three piece intraocular lens (IOL) using a 27-gauge needle for docking. Sutureless techniques have the advantage of not having complex suture manoeuvres, suture-induced inflammation, suture degradation and delayed IOL dislocation from broken sutures. Using a 27-gauge needle has two advantages: the sclerostomy wound will be small enough to be self-sealing, and that the haptic can be docked into the needle and externalised with less risk of haptic damage. The authors also describe 50% thickness scleral cuts 1.5mm in length, parallel to the limbus, 1.7mm from the limbus. One end of the scleral cut is the site of the 27-gauge sclerostomy, and the other end is the start of the scleral tunnel within which the haptic is buried – having a distance of 1.5mm between the sclerostomy and the start of the scleral tunnel means that it is easier to grasp the externalised haptic and insert it into the tunnel. In this case series of 34 patients (average age 67.8 years), the best-corrected logMAR vision increased from 0.48 to 0.17 after three months. The commonest postoperative complications were iris capture (three eyes; 8.6%), transient ocular hypertension (two eyes; 5.7%), and cystoid macular oedema (one eye; 2.9%). In 15 cases, there was follow-up of greater than 12 months – in these cases there were no cases of IOL decentration or significant vision changes. Although this study is limited by its relatively small sample size and short follow-up duration, the results suggest that this is a useful and technically simple technique for sutureless intrascleral IOL implantation in eyes without capsular support.

Sutureless 27-gauge needle-guided intrascleral intraocular lens implantation with lamellar scleral dissection.
Yamane S, Inoue M, Arakawa A, Kadonosono K.
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Brian Ang

Royal Victorian Eye and Ear Hospital, Melbourne, Australia

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