Modified Intraocular Lens Intrascleral Fixation Technique Using Two Vitrectomy Ports as Lens Haptic Fixation Sites

Figures & data

Table 1 Preoperative Status

	Port-Fixation Group (n=21)	Conventional Group (n=12)
Age, years (mean±SD)	47〜84 (72.0±11.2)*	47〜92 (71.0±13.7)*
Gender, male/female	11/10	7/5
Eye, right/left	12/9	8/4
Lens status
IOL subluxation	7	2
IOL dislocated in vitreous	6	2
Lens subluxation/luxation	2	5
Aphakia due to previous vitreoretinal surgery	4	2
Aphakia after complicated cataract surgery	2	1

Notes: *P=0.41, un-paired t test.

Table 2 Procedure for Lens Extraction and Vitrectomy

	Port-Fixation Group (n=21)	Conventional Group (n=12)
Lens/IOL extraction method
Whole IOL extraction with PFCL	5	2
Whole IOL extraction with hook	3	2
Divide into two pieces with scissors	4	1
Lens extraction with fragmatome	2	5
Lens fragment extraction with vitreous cutter	0	1
Scleral fixation re-using a dislocated IOL	1	0
No procedure because of aphakia	6	1
Vitrectomy procedure
Total vitrectomy	12	10
Total vitrectomy with ERM and ILM peeling	1	0
Peripheral vitrectomy	8	2
Total operation time (minutes)	118.3±25.6*	134.0±27.6*

Notes: *P=0.054, un-paired t-test.

Figure 1 Port-fixation group. Representative case, right eye. (A)Supranasal (c) and inferotemporal (b) trocars (25-gauge) were placed in the center of a T-shaped lamellar scleral incision 2 mm from the corneal limbus and a supratemporal trocar (a) was placed 3.5 mm from that. (B, C) Following a vitrectomy, the infusion cannula was changed from an inferotemporal to supratemporal trocar. At the time when the IOL was halfway inserted into the eye (d), the first IOL haptic and a supranasal trocar were simultaneously withdrawn through the sclera by grasping with 25-gauge vitreoretinal forceps. (D, E) The second IOL haptic and an inferotemporal trocar were simultaneously withdrawn through the sclera by grasping with 25-gauge vitreoretinal forceps. (F) Both tips of the IOL haptics were embedded into preliminary intrascleral spaces and the infusion cannula was finally removed.

Figure 2 Conventional group. Representative case,righteye. (A) Supratemporal (a),inferotemporal (b) and supranasal (c) trocars (25-gauge) were placed 3.5 mm from the corneal limbus. Two T-shaped lamellar scleral incisions were placed 2 mm from that (e,f). In the center of T-shaped lamellar scleral incisions,full-thickness scleral perforations were performed with 25-gauge MVR. (B,C) Following a vitrectomy,IOL was halfway inserted into the eye (d) and the first IOL haptic was withdrawn through the scleral perforation site (f) by grasping with 25-gauge vitreoretinal forceps. (D,E) The second IOL haptic was withdrawn through the scleral perforation site (e) by grasping with 25-gauge vitreoretinal forceps. (F) Both tips of the IOL haptics were embedded into preliminary intrascleral spaces (e,f),and two trocars (a,c) and the infusion cannula were finally removed.

Table 3 Postoperative Complications, Pre- and Postoperative Visual Acuity

	Port-Fixation Group (n=21)	Conventional Group (n=12)
Postoperative observation period, months	6〜23 (13.8 ± 5.9)*^a	6〜30 (19.7 ± 8.8)*^a
Postoperative complications
Transient ocular hypotension (>5 days)	2 eyes (10%)	2 eyes (17%)
Transient ocular hypertension (>5 days)	2 eyes (10%)	1 eye (8%)
Exposure of IOL haptics outside of wound	2 eyes (10%)	0 eye (0%)
Strong astigmatism (>5 diopter)	1 eye (5%)	1 eye (8%)
Transient vitreous hemorrhage	1 eye (5%)	1 eye (8%)
Subtotal	6 eyes (29%)*^b	4 eyes (33%)*^b
Postoperative astigmatism (diopter, 6 months)	1.72 ± 1.13*^c	2.21 ± 1.78*^c
Preoperative visual acuity (logMAR)	0.45 ± 0.60*^d	0.59 ± 0.60*^e
Postoperative visual acuity (logMAR, 6 months)	0.36 ± 0.51*^d	0.36 ± 0.50*^e

Notes: *^aP=0.015, un-paired t-test, *^bThere is some overlapping, *^cP=0.17, unpaired t-test, *^dP=0.160, paired t-test, *^eP=0.116, paired t-test.