Abstract
To describe a novel technique for implantation of intraocular lens in the absence of capsular support using a ciliary sulcus guide. Based on the anatomic knowledge of the ciliary sulcus and the sclera, a new instrument was developed to pierce the needle safely through the ciliary sulcus and sclera. While the foldable lens is stored inside the cartridge, the leading haptic is sutured with a cow-hitch knot. The needle is then inserted into the ciliary sulcus guide. The tip of the guide is inserted from the corneal incision and proceeded under the iris to touch and fit the ciliary sulcus. The needle is pushed from back side. The needle comes out at precise point at the sclera. Implantation of the lens was performed through a 2.8 mm clear cornea incision using the injector. The trailing haptic is tied after implantation, and then the same procedure is performed at the opposite side. We performed this technique to 15 aphakic eyes without sufficient capsular support. There was no bleeding or other intraoperative complication. All the points coming out the sclera were between 2 and 2.5 mm from the limbus. The ab interno technique for scleral fixation of IOL is quicker, easier and less traumatic then ab externo techniques. A new ciliary sulcus guide which is usable with both straight and curved needles eliminates the blind maneuvers of ab interno technique and makes this technique more safe and precise.
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References
Por YM, Lavin MJ (2005) Techniques of intraocular lens suspension in the absence of capsular/zonular support. Surv Ophthalmol 50:429–462
Lewis JS (1991) Ab externo sulcus fixation. Ophthalmic Surg 22:692–695
Hanemoto T, Ideta H, Kawasaki T (2001) Dislocated intraocular lens fixation using intraocular cowhitch knot. Am J Ophthalmol 131:265–267
Hoffman RS, Fine IH, Packer M, Rozenberg I (2006) Scleral fixation using suture retrieval through a scleral tunnel. J Cataract Refract Surg 32:1259–1263
Chen SX, Lee LR, Sii F, Rowley A (2008) Modified cow-hitch suture fixation of transscleral sutured posterior chamber intraocular lenses: long-term safety and efficacy. J Cataract Refract Surg 34:452–458
Peden M, Adams S, Huffman B, Kaushal S (2009) Alternative technique for implantation of a scleral-fixated intraocular lens. J Cataract Refract Surg 35:226–229
Gabor SG, Pavlidis MM (2007) Sutureless intrascleral posterior chamber intraocular lens fixation. J Cataract Refract Surg 33:1851–1854
Arkin MS, Steinert RF (1994) Sutured posterior chamber intraocular lenses. Int Ophthalmol Clin 34:67–85
Althaus C, Sundmacher R (1993) Intraoperative intraocular endoscopy in transscleral suture fixation of posterior chamber lenses: consequences for suture technique, implantation procedure, and choice of PCL design. Refract Corneal Surg 9:333–339
Ohta T, Toshida H, Murakami A (2014) Simplified and safe method of sutureless intrascleral posterior chamber intraocular lens fixation: Y-fixation technique. J Cataract Refract Surg 40:2–7
Agarwal A, Kumar DA, Jacob S, Baid C, Srinivasan S (2008) Fibrin glue-assisted sutureless posterior chamber intraocular lens implantation in eyes with deficient posterior capsules. J Cataract Refract Surg 34:1433–1438
Narang P (2013) Modified method of haptic externalization of posterior chamber intraocular lens in fibrin glue-assisted intrascleral fixation: no-assistant technique. J Cataract Refract Surg 39:4–7
Yamane S, Inoue M, Arakawa A, Kadonosono K (2014) Sutureless 27-gauge needle-guided intrascleral intraocular lens implantation with lamellar scleral dissection. Ophthalmology 121:61–66
Apple DJ, Price FW, Gwin T et al (1989) Sutured retropupillary posterior chamber intraocular lenses for exchange or secondary implantation. The 12th annual Binkhorst lecture, 1988. Ophthalmology 96:1241–1247
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Can, E., Gül, A. & Birinci, H. A safe method of ciliary sulcus fixation of foldable intraocular lens using a ciliary sulcus guide. Int Ophthalmol 36, 463–468 (2016). https://doi.org/10.1007/s10792-015-0132-0
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DOI: https://doi.org/10.1007/s10792-015-0132-0