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Ma, Kim, and Wee: Knotless External Fixation Technique for Posterior Chamber Intraocular Lens Transscleral Fixation: A 5-Case Analysis
Original Article
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(11): 1609-1614.

Published online: 19 November 2012

DOI: https://doi.org/10.3341/jkos.2012.53.11.1609

Knotless External Fixation Technique for Posterior Chamber Intraocular Lens Transscleral Fixation: A 5-Case Analysis

Dae Joong Ma, MD1, Mee Kum Kim, MD, PhD1, 2, Won Ryang Wee, MD, PhD1, 2

1Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.

2Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea.

Address reprint requests to Mee Kum Kim, MD, PhD. Department of Ophthalmology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea. Tel: 82-2-2072-2438, Fax: 82-2-741-3187, kmk9@snu.ac.kr

Received 14 September 2011       Accepted 24 September 2012

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

To determine whether the knotless technique can be an alternative for the scleral flap-making technique in posterior chamber intraocular lens transscleral fixation when a scleral flap cannot be made.

Methods

Five patients underwent the knotless technique for posterior chamber intraocular lens transscleral fixation when a scleral flap could not be made. Partial thickness scleral anchoring sutures were repeated three times near the transscleral penetration site in both ends. The end of the anchoring suture was passed under the exposed part of the partial thickness scleral anchoring suture and pulled to adjust the position of the intraocular lens. Then, anchoring sutures were covered with a conjunctival flap. Complications and change of intraocular lens astigmatism were evaluated.

Results

During the 8-month postoperative follow-up period, one case of ciliary body hemorrhage due to intraoperative transscleral penetration and one case of mild intraocular lens tilting owing to the improper tension of the string were observed. Except for one case with a concurrent penetrating keratoplasty, intraocular lens astigmatism showed no significant change during the postoperative follow-up period and no significant difference compared to transscleral fixation with a scleral flap.

Conclusions

Knotless technique for external fixation of posterior chamber intraocular lens transscleral fixation is a safe and easy technique and may be a good alternative for the scleral flap-making technique in posterior chamber intraocular lens transscleral fixation when a scleral flap cannot be made.

Keywords: Decentration, Intraocular lens astigmatism, Knotless, Tilting, Transscleral fixation

Figures and Tables

Figure 1
A knotless technique for the external fixation of the transscleral suture (A) The anchoring suture with partial thickness scleral penetration of 10-0 polypropylene (Prolene, Ethicon, Somerville, NJ, USA), (B) Partial thickness scleral penetrations were repeated three times, (C) The end of the anchoring suture was buried under the exposed part of the anchoring suture. (D) Representative slit-lamp photography after the knotless techniques for external fixation of the transscleral suture.
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Figure 2
Comparison of IOL astigmatism between the external fixation with a knot and the knotless external fixation.
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Table 1
Demographics
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*Optic acrylic intraocular lens with polymethylmethacrylatehaptics (Advanced Medical Optics, Inc.); †Optic acrylic intraocular lens with polymethylmethacrylatehaptics (Hoya Healthcare Corp.); ‡Concomitant penetrating keratoplasty was done.

Table 2
Postoperative complications
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*Ocurred during operation; †Found on the first examination after the operation, 1 days after the operation.

Table 3
Pre and postoperative visual acuities, refractive errors and IOL astigmatisms
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BVCA = best-corrected visual acuity; log MAR = logarithm of the minimum angle of resolution; SE = spherical equivalent, D = diopters.

*One case with concurrent penetrating keratoplasty was excluded; †Mean 20.5 days after operation (8-40 days); ‡By power vector analysis; §Underlying glaucoma, anterior uveitis and cystoid macular edema.

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