Publication Exclusive: Glued intrascleral posterior chamber IOL fixation technique continues to evolve

Suturing of posterior chamber IOLs in back of the iris or the capsular bag is standard practice, but it may not be appropriate in cases with insufficient capsule, lens subluxation or loss of zonular integrity.

In the last decade, surgeons began to perform posterior chamber IOL implantation using an intrascleral haptic fixation technique, with or without sutures. Experts say the technique and its variants enhance the long-term stability of posterior chamber IOLs.

Sutureless intrascleral haptic fixation of a three-piece posterior chamber IOL in eyes with no capsular support was reported by Scharioth and colleagues in 2007. The original sutureless technique involved tucking the IOL haptics into scleral tunnels parallel to the limbus, with no suturing or gluing.

Also in 2007, Amar Agarwal, MS, FRCS, FRCOphth, OSN APAO Edition Board Member, and colleagues introduced a glued intrascleral haptic fixation technique. Agarwal later devised a series of variants such as the handshake technique and the trocar anterior chamber maintainer.

Soosan Jacob, MS, FRCS, DNB, OSN APAO Edition Board Member, devised the glued capsular hook. Priya Narang, MS, devised the no-assistant technique to make glued IOL surgery easier.

“Why do glued IOLs work so well? One, it is definitely easier and faster than a sutured lens technique,” Agarwal said. “But the bigger advantage is that the lens is very stable. It does not move. Also, there is generally no tilting of the lens, which can happen in a sutured lens.”

Narang said that glued intrascleral posterior chamber IOL fixation significantly reduces phacodonesis and pseudophakodonesis. This has been recorded on high frames per second on the iPhone and also on high-speed cameras.

“If you have an IOL that is moving in the eye with the eye movement, like you have in an iris fixation, or you have a sutured IOL or you have an anterior chamber IOL, there’s an element of pseudophakodonesis,” Narang said.

Eric D. Donnenfeld, MD, OSN Cornea/External Disease Board Member, said there are various advantages of the glued IOL technique.

“What I have liked about the glued IOL technique is that it allows for very good fixation and centration, and very rarely do you have lens tilt. ... I found both of those issues to be problems with scleral-fixated lenses using sutures,” Donnenfeld said. “The other advantage is that you don’t have to worry about the suture degrading over time. And, most importantly, I believe, from a surgeon’s perspective, the amount of dexterity required for this technique is really on par or less than the amount of dexterity required for the other procedures. In the right hands, I believe it’s actually an easier technique than the other techniques we’re using currently. I don’t use this technique exclusively, but I use it in a majority of my cases now.”

Click here to read the full cover story published in Ocular Surgery News U.S. Edition, July 25, 2015.