Volume.125 Number.9

Original article : Clinical science

Evaluation of Surgical Outcomes of Intrascleral Intraocular Lens Fixation Using Extraocular Forceps-guided Technique
Yasuhiko Asano, Yoshihiro Wada, Yuta Saito, Kunimi Fujisawa, Hidetoshi Onda
Department of Ophthalmology, Showa University School of Medicine

Purpose: This study aimed to evaluate the utility of intrascleral fixation of intraocular lenses (IOLs) using an extraocular forceps-guided technique.
Subjects and methods: This study involved 58 eyes of 55 consecutive patients who were followed up for at least three months after undergoing extraocular forceps-guided intrascleral IOL fixation from April 2019 to October 2020 at Showa University East Branch. The surgical procedures were as follows: An IOL was inserted into the anterior chamber, and the leading haptic was inserted into the lumen of a 27-gauge needle, which penetrated through the sclerotic coat. The trailing haptic was kept outside the oculus. Subsequently, intrascleral curved forceps 25-gauge (M. E. Technica) for extraocular guidance were inserted into the eye from a sclerotomy, 180 degrees opposite from the initial sclerotomy, and protruded through the sclerocorneal incision. The tip of the trailing haptic that was kept outside was grasped by the forceps. Finally, both leading and trailing haptics were pulled out simultaneously to the extraocular space and were then buried into the scleral tunnel. The surgical outcomes of this modality were subjected to evaluation.
Results: The mean total surgical duration and the surgical duration from IOL insertion to haptics burying were 46.7±12.0 (mean±standard deviation) minutes and 7.2±3.1 minutes, respectively. No intraoperative complications were observed. The postoperative follow-up period was 11.2±5.8 months. The postoperative complications included temporary ocular hypotension in 3 eyes (5.2%), cystoid macular edema in 3 eyes (5.2%), vitreous hemorrhage in 3 eyes (5.2%), iris capture by IOL in 1 eye (1.7%), IOL dislocation in 1 eye (1.7%), retinal detachment in 1 eye (1.7%), and macular hole in 1 eye (1.7%). The mean corrected distance visual acuity (logarithmic minimum angle of resolution: logMAR) was 0.54±0.61 (mean±standard deviation) preoperatively and 0.26±0.45 (mean±standard deviation) postoperatively, showing a significant improvement (p< 0.01). The mean IOL astigmatism was 0.38±0.36 diopters, and the mean corneal endothelial cell density loss was 12.9±14.9%.
Conclusions: Using the extraocular forceps-guided technique, we succeeded in easily guiding the trailing haptic from the extraocular space. Accordingly, this technique can be considered a viable surgical option in the future.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 125: 902-910,2021.

Key words
Extraocular forceps-guided technique, Extraocular technique,, Intrascleral intraocular lenses fixation, Surgical outcomes
Reprint requests to
Yasuhiko Asano, M. D. Department of Ophthalmology, Showa University East Branch. 2-14-19 Nishinakanobu, Shinagawa-ku, Tokyo 142-0054, Japan