Scleral fixation for secondary IOL can be efficient if mastered
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CHICAGO — Using scleral fixation can be an effective and efficient method of implanting a secondary IOL, according to an expert at Retina Subspecialty Day at the American Academy of Ophthalmology meeting.
Christina Y. Weng, MD, MBA, said there are several options for patients who do not have adequate capsular support for secondary IOLs, but the use of trocar-based sutureless scleral-fixated IOLs has gained popularity.
“This has become my go-to technique,” she said. “I not only find it very effective, but it can be incredibly efficient once the technique is mastered.”
In the preoperative stage, Weng said it is important to ensure the conjunctiva is mobile, avoid creating bullous conjunctiva with retrobulbar block, obtain calculations for multiple IOLs, and aim for –0.5 D to plano to ensure the best refractive outcomes.
When beginning surgery, Weng said getting clean marks centered around the cornea, not the pupil, is the most important step. She also encouraged depressing at the sulcus to ensure complete removal of the capsule and ensuring the trocar entry is symmetrical.
Weng said she uses a hand-to-hand technique in which she passes the IOL haptic between two forceps to ensure she can correctly grasp the end before externalizing.
“Hand it off to yourself. Walk yourself all the way up to the haptic tip,” Weng said. “I ask my assistant to guard the first haptic so I don’t inadvertently draw it back in when I’m externalizing the second.”
Finally, Weng said when burning the haptic tips, it is important to not grab too close to the haptic tip, not to contact the tip with the cautery, and to dry and elevate the haptic off the surface.
“This technique is not just effective, it also can be really efficient,” Weng said. “We do need data on long-term stability outcomes, as well as the optimal IOL formulas to apply.”
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Weng CY. Simplifying scleral-fixated IOL surgery. Presented at: American Academy of Ophthalmology meeting; Sept. 30-Oct. 3, 2022; Chicago.
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