Scleral Fixation of Intraocular Lens Using Gore-Tex Suture

The Akreos AO60 IOL must be threaded in a “U-shaped” pattern by passing a Gore-Tex suture through one haptic from anterior to posterior, and then through the other haptic on the same side from posterior to anterior. This pattern is repeated on the contralateral side of the IOL with another suture. The suture ends are passed through a corneal incision and pulled out through each of the corresponding trocars using a hand-to-hand technique with forceps. After the suture ends are passed, the Akreos AO60 IOL is folded and inserted into the posterior chamber. Then, the trocars are removed and the suture ends are pulled to centralize the lens. The sutures are tied and the knots are trimmed and buried into the sclerotomy incisions. Last, the sclerotomies, corneal incisions and conjunctival peritomies are closed. After closing the incisions, none of the Gore-Tex sutures should be exposed.

Indications include dislocated IOL, aphakia with poor capsular support, subluxated crystalline lens, traumatic cataract, corneal decompensation, unamenable iris anatomy for iris fixation, concurrent need for pars plana vitrectomy, and uveitis-glaucoma-hyphema syndrome.

Relative contraindications include uveitis, endothelial dysfunction, corneal dystrophy, retinal hole, subretinal fluid, extensive lattice degeneration or major retinal diseases.

Akreos AO60 IOL
Gore-Tex suture

Set up requires an inferior infusion cannula, nasal and temporal conjunctival peritomies, and four 27G trocars in the inferior nasal, inferior temporal, superior nasal, and superior temporal positions. Prior to implantation of the lens, a pars plana vitrectomy can be performed.

Preoperative workup includes calculating the IOL power and measuring visual acuity and intraocular pressure.

N/A

No intraoperative complications of scleral-fixated IOLs have ever been reported. Post-operative complications are largely transient and most can be treated medically with topical therapies. Commonly reported complications are vitreous hemorrhage, corneal edema, ocular hypertension, hypotony, cystoid macular edema, and hyphema. Retinal detachment is rare. Ophthalmic use of Gore-Tex has positive visual outcomes without significant complications.

None

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