Posters

Sutureless scleral small incision removal of a dislocated PMMA IOL and flanged scleral haptic fixation of a 3-piece IOL with double-needle technique

Poster Details

First Author: H.Tossounis UK

Co Author(s): T. Sepetis   S. Lash   B. Gupta   H. Elkayal           

Abstract Details

Purpose:

To present a sutureless technique for removal of dislocated PMMA IOLs and the use of a flanged scleral haptic fixation(SHF) 3-piece IOL with the double-needle technique on a patient with a high risk of endothelial decompensation.

Setting:

A patient with a dislocated PMMA IOL in one eye and an ACIOL with a bullous keratopathy treated with an endothelial graft on the other eye presented at the vitreoretinal clinic of University Hospital Southampton for removal of the dislocated IOL and insertion of a scleral haptic fixation 3-piece IOL.

Methods:

A 68-year old patient was referred at the vitreoretinal clinic of University Hospital Southampton because of a sudden painless drop in vision of the right eye due to a dislocated PMMA IOL. A sutureless small incision scleral tunnel was constructed through which the dislocated bag and PMMA IOL were removed from the eye. The second phase included the insertion of a 3-piece acrylic IOL in the anterior chamber and the transconjunctival intrascleral intraocular lens fixation with the double-needle and flanged-haptic technique. The scleral tunnel was self-sealing and the conjunctiva was sutured back to the limbus.

Results:

2 weeks post surgery the eye was quiet and the scleral fixated IOL was centred. The BCVA was 0.18 LogMar and the IOP 10mmHg.

Conclusions:

The sutureless scleral small incision technique is very convenient for removal of rigid PMMA IOLs, which could pose several dangers if attempted to be cut in the eye. However, the tunnel construction requires careful steps in order to achieve a self-sealing status; otherwise, it could prove very challenging and could make the IOL removal and SHF IOL insertion difficult. The SHF IOL technique feels “fiddly” but it can deliver good visual outcomes and could be a useful solution when there is no capsular support present and the corneal endothelium health is important.

Financial Disclosure:

None