Korean J Ophthalmol.  2018 Feb;32(1):23-28. 10.3341/kjo.2017.0038.

Temporary Haptic Externalization and Four-point Fixation of Intraocular Lens in Scleral Fixation to Enhance Stability

• Shin JY
• Choi SR
• Jeon JH
• Kang JW
• Heo J

• KMID: 2402716
• DOI: http://doi.org/10.3341/kjo.2017.0038

Abstract

PURPOSE
To report the results of a new technique for intraocular lens scleral fixation of temporary haptic externalization and four-point fixation for enhanced stability.
METHODS
Two 10-0 polypropylene strands were fixed at two points 2 mm apart on each haptic of a conventional three-piece intraocular lens, using our previously reported method of temporary haptic externalization after injector implantation. Postoperative refractive outcome and stability were evaluated.
RESULTS
Although the intraocular lens was fixed at a total of four points, no intraoperative difficulties were observed during the process. Patients showed successful fixation of the intraocular lens postoperatively. The fixed intraocular lens showed good centering and minimal tilting. When compared to the two-point fixation technique, postoperative astigmatism was significantly smaller in the four-point fixation group (1.80 ± 0.84 vs. 1.00 ± 0.0.50, p = 0.033). Lens-induced astigmatism calculated from subtraction of corneal astigmatism from total astigmatism was also significantly smaller in the four-point fixation group (2.23 ± 0.98 vs.1.17 ± 0.0.70, p = 0.043). No postoperative complications were identified during a mean follow-up period of 14.8 months (range, 10 to 19 months).
CONCLUSIONS
By fixing the intraocular lens at two points on each side of the haptics, this method minimizes the tilting of the intraocular lens and thus decreases postoperative lens-induced astigmatism. Also, the possibility of intraocular lens dislocation in the long term might be decreased by this two-point fixation technique.

Keyword

Aphakia; Astigmatism; Cataract; Lens subluxation

MeSH Terms

Aphakia
Astigmatism
Cataract
Dislocations
Follow-Up Studies
Humans
Lens Subluxation
Lenses, Intraocular*
Methods
Polypropylenes
Postoperative Complications
Polypropylenes

Figure

• 

  Fig. 1 Schematic drawing of the procedure of temporary haptic externalization and four-point fixation in scleral fixation of the intraocular lens (surgeon's view from the superior of eye). (A) Double-armed 10–0 polypropylene sutures are passed through the sclera and across to the opposite side. (B) The suture thread closer to the 3 o'clock side is pulled through the 3 o'clock corneal incision and cut in two. (C) 12 o'clock end is pulled out through the 9 o'clock corneal incision. (D,E) A 3-piece intraocular lens is inserted through the 3 o'clock corneal incision site. The haptics should be pulled out through the 3 and 9 o'clock incisions. The previously passed sutures are tied to each haptic. (F) The intraocular lens is inserted into the anterior chamber and then into the posterior cavity while gently pulling the sutures at 6 and 12 o'clock.

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