27-gauge needle-assisted externalization and haptic securing technique for sutureless scleral fixation of the intraocular lens – moving toward simplicity

Figures & data

Figure 1 Steps of our 27-gauge needle-assisted externalization and haptic securing technique.

Notes: (A) Labeling 2mm from limbus-180 degree apart. (B) 27G needle introduction aiming mid vitreous. (C) Externalized via main tunnel-guided by visco-canula. (D) Loading the IOL haptic into the 27G needle. (E) Externalizing the haptic. (F–H) Same procedure repeated on the other side. (I) Tunnel creation for using 27G needle. (J–L) Docking the haptic into the scleral tunnel.

Figure 2 3D – steps of our 27-gauge needle-assisted externalization and haptic securing technique.

Notes: (A) Entry of the 27G needle aiming mid vitreous. (B) Visco-Canula used to engage the tip of the 27G needle and externalisation. (C) Loading of the haptic into the lumen of the syringe. (D) Externalization of the haptic-secured by stopper. (E) Same procedure repeated on the other side. (F) Tunnel creation for the haptic docking using 27G needle. (G) Docking the haptic.
Abbreviation: 3D, three dimensional.

Figure 3 Method of loading the “stopper” to the 27-gauge needle which prevents the haptic from slipping back into the vitreous cavity after externalization.

Notes: (A) Silicon sleeve – which later acts as stopper being loaded to the bent 27-gauge needle. (B) Final position of the stopper.

Table 1 Baseline, indications and postoperative characteristics of scleral-fixated IOL

Particulars
Number of eyes (patients)	92
Age, years (median, range)	51 (17–80)
Sex (male/female)	61/31
Laterality (right/left)	50/42
Primary SFIOL implantation	56 eyes (61%)
Secondary SFIOL implantation	36 eyes (39%)
Diagnosis
Dislocated/subluxated lens	50
Aphakia	31
Dislocated/subluxated PC-IOL	5
Baseline logMAR BCVA (mean SD)	1.56 (0.25)
LogMAR BCVA at 6 weeks (mean SD)	0.08 (0.18)

Abbreviations: BCVA, best-corrected visual acuity; IOL, intraocular lens; logMAR, logarithm of the minimum angle of resolution; PC-IOL, posterior chamber intraocular lens; SFIOL, scleral fixated IOL.

Table 2 Special cases: their baseline and postoperative characteristics

SFIOL in special conditions	Number of cases	Baseline logMAR BCVA (mean SD)	LogMAR BCVA at 6 weeks (mean SD)
Healed postoperative endophthalmitis	3	1.48 (0.81)	0.47 (0.09)
Post pars plana vitrectomy with silicon oil implant for retinal detachment	2	1.77 (0.43)	0.30 (0)
Marfan’s syndrome	1	1.77 (0)	0.30 (0)

Abbreviations: BCVA, best-corrected visual acuity; logMAR, logarithm of the minimum angle of resolution; SFIOL, scleral fixated IOL.

Figure 4 The pattern of preoperative, postoperative, and 6th week postoperative change in visual acuity.