J Korean Ophthalmol Soc.  2012 Dec;53(12):1783-1788. 10.3341/jkos.2012.53.12.1783.

Clinical Results of Modified Ab Externo and One-Knot Technique

• Jung MO
• Koh JW

• KMID: 2216391
• DOI: http://doi.org/10.3341/jkos.2012.53.12.1783

Abstract

PURPOSE
To introduce a more efficient and time-saving scleral fixation technique for a posterior chamber foldable intraocular lens and to report the clinical results.
METHODS
A foldable acrylic 3-Piece IOL was sutured to the sclera via a small corneal incision. The guiding hollow needle was not used, which differs from other ab externo techniques. Instead, the curved long needle was directly pulled out through the cornea. The scleral flap was not used to bury the scleral suture knot; Instead, the scleral suture knot was translocated at the temporal area.
RESULTS
A total of 30 cases were studied retrospectively. The mean follow-up period was 2 years. The IOL was correctly positioned in all cases. There were no major complications, such as endophthalmitis or suture erosion through the conjunctiva.
CONCLUSIONS
Based on the authors' experience, the modified ab externo and one-knot technique is a faster and easier technique than the conventional ab externo technique.

Keyword

Ab externo; Knot exposure; Transscleral fixation

MeSH Terms

Cornea
Endophthalmitis
Follow-Up Studies
Lenses, Intraocular
Needles
Retrospective Studies
Sclera
Sutures

Figure

• 

  Figure 1 Summary of the Surgical procedure. (A) After careful conjunctival periotomy, two entry sites directed at 5 and 11 o'clock (point A and B) were marked on the sclera, 1.0 mm posterior to the limbus. (B) Two long curved needles with a double-armed 10-0 polypropylene suture were used in this procedure. (C) Different from other ab externo techniques, the needle was pulled out directly through the peripheral cornea (the yellow circle). The green arrow indicates direction of the needle. (D) The second needle passed through the sclera at the 180 degree opposite direction of the first entry site (point B). (E) The sutures were tied securely to each haptic of 3-piece foldable acrylic IOL. (F) The long curved needle was passed from each point of fixation through the sclera, 3 mm posterior and parallel to the limbus. Each intra-scleral suture is advanced in a lamellar fashion and directed to the temporal area to avoid exposure which can be promoted by frictional blinking movement. The schematic drawing shows how the suture is placed. Two red dot lines in the schematic drawing show the passage of the sutures. The green arrow in the raw figure and the red star in the schematic drawing indicate the suture knot left directly over the bare sclera without burying it.

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  Figure 2 Mean BCVA and refractive index, Mean BCVA (log MAR), SE (D) and Sph (D) showed statistically significant differences after surgery (p < 0.001, p = 0.002, p = 0.005, respectively). Only Cyl value showed statistically insignificant result. BCVA = best corrected visual acuity; SE = spherical equivalent; Sph = spherical refraction; Cyl = cylindrical refraction.

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