OUTCOMES OF FIXATING SUBLUXATED INTRAOCULAR LENSES WITH CAPSULAR BAG TO THE SCLERA USING THE BELT-LOOP TECHNIQUE WITH 6/0 PROLENE IN A TERTIARY EYE HOSPITAL

To evaluate the outcomes of cases with subluxated intraocular lenses (IOL) along with the capsular bag, fixed to the sclera using prolene sutures with the belt-loop technique (McCabe technique), without lens extraction.

Beyoglu Eye Training and Research Hospital

In this retrospective study, cases in which subluxated intraocular lenses (IOLs) were fixed to the sclera using the McCabe technique between January 2022 and April 2024 were analyzed. Preoperative and postoperative refractive errors, IOL positioning, and surgical duration were documented. Preoperative and final follow-up uncorrected and corrected distance visual acuities (UDVA and CDVA) as well as intraocular pressures (IOP) were compared.

Twenty-three eyes of 23 patients were included in the study, with a mean age of 72.1 ± 16.7 years. The mean follow-up period was 7.2 ± 6.3 months (range: 1–18 months). All eyes had inferiorly subluxated intraocular lenses (IOLs), with subluxation attributed to trauma in 9 eyes (39.1%) and pseudoexfoliation in 14 eyes (60.9%). The mean duration from the patient's initial surgery to scleral fixation was 122.6 ± 81.8 months (range: 4–360 months). The average surgical duration was 38.5 ± 15.6 minutes (range: 20–80 minutes). In nine eyes, the IOL was fixed to the sclera via its superior haptic, while in 13 eyes, fixation was performed using both haptics. In one eye, fixation was achieved at three locations due to the three-haptic design of the IOL. In two cases, the capsular tension ring, along with the dislocated IOL, was included in the belt loop and fixed to the sclera. Anterior vitrectomy was performed in 5 eyes (21.7%). Postoperatively, the IOL was centralized in 21 eyes (91.3%), while one eye (4.3%) remained inferiorly subluxated and one eye (4.3%) nasally subluxated. Both UDVA and CDVA showed significant improvement after surgery (p<0.001; preoperative UDVA: 1.2 ± 0.6 and postoperative UDVA: 0.6 ± 0.4; preoperative CDVA: 1.0 ± 0.7 and postoperative CDVA: 0.4 ± 0.4). IOP remained similar before surgery and at the last follow-up (p>0.05).

The belt-loop/McCabe technique, which can be defined as a relatively minimally invasive surgery that can be performed in a short duration without the necessity for vitrectomy in most cases. This technique can be an effective and safe option for achieving lens centration in subluxated IOLs along with the capsular bag.