Purpose: To describe a new surgical technique that combines four-point, flanged polypropylene scleral fixation with a hydrophobic intraocular lens (IOL).
Methods: Using the Envista MX60 and 6.0 polypropylene, scleral four-point fixation was achieved using a flanged-suture technique five times in a model eye and in a case series of eight patients, retrospectively reviewed. The polypropylene is passed through each eyelet in a novel configuration Loop to Optic and Trailing ends to Outside. Conjunctival peritomies, scleral flaps/pockets, glue, and suture knots are avoided. The load needed for haptic fracture and scanning electron microscopy at fracture sites were studied.
Results: Haptic fracture occurred once following the first model eye implantation due to excessive suture tension. The fracture load was similar between the Loop to Optic and Trailing end to Outside and the simple-pass technique (1.08 ± 0.52 N vs. 1.09 ± 0.32 N), suggesting no safety compromise. Scanning electron microscopy did not disclose the cheese-wiring effect. Over a mean follow-up of 10.8 months (range: 3-19; median 11.5 months), all cases experienced visual improvement with best-achieved-postoperative uncorrected visual acuity of 20/25 to 20/200, and the IOL was well-centered. Postoperative IOL tilt averaged 2.9° (range: 0-9.6; median: 2.9°). Two patients developed postoperative cystoid macular edema treated topically. The first case developed flange extrusion that was readily repaired in the clinic.
Conclusion: This novel technique adds two main advantages to previously described flanged-suture techniques: 1) four-point fixation of a hydrophobic IOL; 2) immediate application at the time of initial complicated cataract surgery because it requires no additional supply, IOL, or instrumentation.