Sutureless 27-gauge needle-guided intrascleral intraocular lens implantation with lamellar scleral dissection

Purpose: To report a new technique for performing sutureless intrascleral fixation of a posterior chamber intraocular lens (IOL).

Design: Prospective, noncomparative, interventional case series on the results of sutureless intrascleral fixation of a posterior chamber IOL.

Participants: Thirty-five eyes of 34 consecutive patients with aphakia, dislocated IOL, or subluxated crystalline lens who underwent posterior chamber sutureless implantation of an IOL were studied.

Methods: The haptics of the IOL were externalized with a 27-gauge needle passed through the ciliary sulcus using the double needle technique. The haptics were fixed in a scleral tunnel made by lamellar scleral dissection. The postoperative tilt of the IOL was measured by swept source optical coherence tomography.

Main outcome measures: The best-corrected visual acuity (BCVA), corneal endothelial cell density, IOL tilt, and complications were determined.

Results: The IOLs were fixed with exact centration and axial stability. No wound leakage was seen even without any sutures. The mean BCVA was 0.48 logarithm of the minimum angle of resolution (logMAR) units preoperatively and 0.17 logMAR units at 3 months postoperatively (P = 0.003). The mean corneal endothelial cell loss was 6.0±7.3% (P = 0.63) at 3 months. The mean IOL tilt was 2.3±1.9°. The postoperative complications included iris capture by the IOL in 3 eyes (8.6%), ocular hypertension in 2 (5.7%), and cystoid macular edema in 1 (2.9%). There was no postoperative retinal detachment, endophthalmitis, IOL dislocation, or vitreous hemorrhage.

Conclusions: The 27-gauge needle-guided intrascleral posterior chamber IOL implantation technique provides good IOL fixation with reliable wound closure without the use of any sutures. We recommend this technique for secondary IOL implantation.