4-Point scleral fixation technique using Gore-tex® sutures for cut-out plated haptic intraocular lenses

Abstract

Purpose: To report a 4-point scleral fixation technique utilizing Gore-tex® CV8 sutures and cut-out plated haptic intraocular lenses (IOLs) lacking a 4-eyelet haptic design for aphakic patients. Observations: This scleral fixation technique utilizes Gore-tex CV8® sutures paired with a foldable, monofocal, cut-out plated haptic IOLs wherein the sutures are passed through the holes of the plate haptics. Initially, sectoral conjunctival peritomies are performed on the temporal and medial conjunctiva. This is followed by the creation of 4 sclerotomy sites 5mm from each other and 2mm from the limbus at the exposed medial and temporal sclera. A Gore-Tex® (CV8) suture is threaded under the plate haptic. The leading suture is then inserted intraocularly through the corneal incision and externalized through the inferior sclerotomy. The trailing end of the suture which is over the haptic plate is passed intraocularly and externalized through the same port. The externalized suture is brought back intraocularly through the superior sclerotomy and then re-externalized through the corneal incision. This suture end is then threaded through the superior portion of the plate haptic in an over-under fashion. The suture which has passed under the haptic plate, is then brought back intraocularly through the corneal incision and externalized through the superior sclerotomy creating a loop. The same steps are then performed on the contralateral side. The IOL is then inserted. Centration of the IOL is then achieved by adjusting the tension on the 4 externalized suture ends. The Gore-Tex® sutures are then tied and subsequently buried into the sclerotomy. Conjunctival peritomies are then repaired. Conclusions and importance: Four-point fixation of cut-out plate haptic IOLs is achievable with predictable outcomes showing good centration, stability, visual and refractive outcomes providing surgeons additional options for fixation of available lenses as a secondary or primary implantation or by fixation of subluxed or dropped plate IOLs.