Scleral Fixation Of Toric Intraocular Lens In The Absence Of Capsular Support - New Use Of “Pseudo–4-Point” Technique

To present a technique for scleral fixation of toric intraocular lens in eyes with the lack of capsular support coexisting with corneal astigmatism and report its preliminary clinical outcomes.

Department of Ophthalmology, Military Institute of Medicine, Szaserów Street 128, 04-141 Warsaw, Poland.

A monofocal toric hydrophobic lens (enVista One-Piece Hydrophobic Acrylic MX60T Toric IOL; Bausch & Lomb) was fixated to the sclera with two fragments of 6–0 polypropylene monofilament, the ends of which were brought out through the sclera and cauterized. The astigmatic axis of a TIOL was adjusted according to the corneal astigmatic axis of the patient. The surgery was performed in 6 eyes of 6 patients. During the follow-up visits uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), preoperative corneal cylinder, postoperative refractive cylinder, slit lamp examination, applanation tonometry and Anterion exam were evaluated. We also collected data on the operated eye, surgical technique and complications.

This technique was used in 6 eyes of 6 patients with corneal astigmatism greater than or equal to 2.0 D (mean 2.93 diopters; ± 0.82 (SD) (range 2.00-4.25 D). The mean follow-up was 3.66 months, ± 0.58 (SD) (range 3-4 months). There were no surgical complications that affected visual function during the postoperative period. The mean preoperative and postoperative corrected distance visual acuities (CDVA) on Snellen chart were 0.4 ± 0.27 (SD) (range 0.1-0.8) and 0.9 ± 0.20 (SD) (range: 0.5-1.0) respectively. The mean preoperative corneal astigmatism was 2.93 diopters; ± 0.82 (SD) (range 2.00-4.25 D), while mean postoperative refractive astigmatism was 1.0 diopter; ± 0.27 (SD) (range 0.75-1.5 D), respectively.

Scleral fixation of the MX60T TIOL in the eyes without capsular support, using the eyelets located at the optic–haptic junction for suture placement, provides good results if comes to reduction of astigmatism.“Pseudo four-point” fixation gives adequate support of the lens without the risk of axis change of toric IOL after surgery. No need to create flaps, make a knots or use glue in this approach makes the procedure faster, easier to perform and minimalizes ocular trauma.