Scleral fixation of toric IOLs

Session Details

Session Title: Cataract Surgery Special Cases II

Session Date/Time: Monday 15/09/2014 | 16:30-18:30

Paper Time: 17:38

Venue: Auditorium

First Author: : O.Le Quoy FRANCE

Co Author(s): :                  

Abstract Details

Purpose:

Corneal astigmatism . is frequently associated with capsular deficiencies requiring scleral fixated IOL’s in clinical situations such as trauma, eventful phaco, Marfan syndrome and luxated lens or IOL.

Setting:

Private Hospital Practice

Methods:

15 patients were operated on between May and December 2013. Astigmatism varied from 1.75 to 4 diopters. Our series includes 5 cases of IOL's luxation, high myopia (3 cases), pseudoexfolliation (3 cases) , 4 cases of ocular trauma, 4 cases of eventful phaco and one case of Marfan syndrome. Mean age was 70 years old (44 years to 84). IOL power was calculated by raytracing. A 25 gauge posterior vitrectomy is associated with a sutureless sclerocorneal incision (4 mm wide) whose superotemporal localization ,depends on the astigmatism axis which is marked with ink on the cornea. Then the lens is brought into alignment with the corneal marks and the projection of the haptic ends are cauterized at the limbus.Vitrectomy combined removal of luxated lens if necessary, peripheral retinal examination, sulcus localization by transillumination on the axis previously marked at the limbus and superior iridotomy. Implantation is done with a hydrophobic monobloc IOL, 6 mm diameter optic and 13 mm overall haptics angulated at 5°. Each haptics is fixated with 2 10/0 Prolene sutures placed at their extremity 1mm apart and placed in the sulcus and sutured 2 by 2 on the adjacent sclera.

Results:

: In all but one of the cases, astigmatism was very well corrected. (the average post op cylinder was .25 D (0 – .75D) In one case only partially due to initial too high power. The right spherical correction was reached in all cases. In this short series we had no complication due to implantation technic. No ocular hypertension, no rétinal detachment and no endophtalmitis. Postoperative visual acuity depended on the potential of macular function

Conclusions:

In case of capsular defects, and when necessary toric lenses can be sclerally sutured with no risk of secondary dislocation. Beyond our expérience, sutured fixation could be used in case of very high astigmatism as soon as such toric IOL’s will be produced.

Financial Interest:

NONE