Clinical Ophthalmology (Nov 2023)
Modified Four-Point Scleral Fixated Sutured Posterior Chamber Intraocular Lens Implantation Using 2 Eyelets Polymethyl Methacrylate Lens and 8-0 Polypropylene Suture
Abstract
Natalia Christina Angsana,1 Firman Setya Wardhana,1 Supanji,1 Mohammad Eko Prayogo,2 Muhammad Bayu Sasongko1 1Department of Ophthalmology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada – Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta, Indonesia; 2Department of Ophthalmology, Universitas Gadjah Mada Academic Hospital, Yogyakarta, IndonesiaCorrespondence: Muhammad Bayu Sasongko, Department of Ophthalmology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada – Sardjito Eye Center, Dr. Sardjito General Hospital, Jalan Farmako Sekip Utara, Yogyakarta, Indonesia, Tel/Fax +62 274 552850, Email [email protected]: To present a modified technique of 4-point scleral fixation using polymethyl methacrylate (PMMA) 2 eyelets intraocular lens (IOL) with 8-0 polypropylene sutures.Methods: A 270-degree conjunctival peritomy is done, and 4 sclerotomies (2 nasal and 2 temporal) are created. Lamellar scleral or clear corneal incision is made at superior site (6 mm wide for sclera or 5.5– 6 mm for corneal). A short segment of 8-0 polypropylene is inserted into each eyelet, each thread of the suture is externalized through the sclerotomy site, and the lens is inserted. The suture is tightened evenly, and the knot is rotated and internalized. Scleral incision and conjunctival peritomy are sutured with 8-0 vicryl.Results: We have performed this technique in 6 patients with excellent visual outcomes and no reported complications over 1 year of follow-up. This technique has practical advantages including rigid and stable PMMA IOL, high tensile, and slim 8-0 polypropylene suture which is easily internalized and less irritated, and affordable and widely available overall consumables.Conclusion: We present a modified 4-point scleral fixation technique for posterior chamber IOL placement using PMMA IOL with 2 eyelets and 8-0 polypropylene as compared to previous studies that used foldable IOL with 4 eyelets and 10-0 polypropylene or Gore-Tex sutures. This procedure has moderate technical complexity, comparable to previously reported techniques with good overall clinical outcomes and several practical advantages, particularly related to the affordability and availability of the consumables.Plain Language Summary: This paper presents a modification of currently existing 4-point sutured scleral fixation technique for posterior chamber intraocular lens implantation using PMMA IOL with 2 eyelets using 8-0 polypropylene. This technique has some practical advantages compared to previously reported techniques with potential applicability in low-resource setting.Keywords: sutured scleral fixation, four-point, polymethyl methacrylate, 2-eyelets, secondary intraocular lens implantation
