Sutureless intrascleral fixation: Simplified technique that eliminates scleral flaps

The new procedure eliminates the need for scleral flaps by positioning the T-shaped IOL haptics in the scleral wall.

Andrea Gabai, MD, and colleagues from the Department of Ophthalmology, University Hospital of Udine, Udine, Italy, reported1 the results obtained with a simplified intrascleral fixation technique that includes implantation of the Carlevale FIL-SSF intraocular lens (IOL) (Soleko) in the posterior chamber. This is a 1-piece foldable IOL specifically designed for sutureless intrascleral fixation.

The new procedure eliminates the need for scleral flaps by positioning the T-shaped IOL haptics in the scleral wall, he explained.

This change is accompanied by a number of advantages according to the physicians. Specifically, the surgical time is reduced, any iatrogenic scleral damage is limited, and friction between the haptics and conjunctiva is eliminated, thus preventing conjunctival erosion and infection over the long term.

Gabai reported that the technique was used in 13 patients in whom the crystalline lens or an IOL had become dislocated or subluxation. The Carlevale IOL was implanted in the posterior chamber to address these issues.

The patients’ preoperative mean corrected distance visual acuity was 0.75 ± 0.5 logarithm of the minimum angle of resolution (logMAR) visual acuity (range, 0.2-1.5 logMAR) and improved to 0.28 ± 0.3 logMAR (range, 0-1.0 logMAR) postoperatively, Gabai reported.

Rare non-sight-threatening complications occurred, such as early transient and self-limiting vitreous hemorrhage in 1 case with bleeding from a sclerotomy, and mild endophthalmitis in 1 patient. The duration of the surgery 60 ± 16 minutes (range, 37-90 minutes).

The authors concluded, “Carlevale IOLs represent a valid and advantageous option in sutureless scleral fixation surgery in the treatment of IOL subluxation and IOL bag dislocation. Our simplified intrascleral fixation technique, which does not require scleral flaps, is advantageous in reducing operative time, providing proper IOL stability, and reducing postoperative complications and conjunctival erosions even after long follow-ups.

  1. Gabai A, Zeppieri M, Toneatto G, Salati C. Enhanced surgical technique for sutureless intrascleral fixation of intraocular lenses. J Cataract Refract Surg. 2021;47:e75-e70; doi: 10.1097/j.jcrs.0000000000000700