Novel use of an adjustable single 8-0 polypropylene suture of scleral fixation without conjunctival dissection

Abstract

Background: This report serves to describe the use of a novel adjustable single 8-0 polypropylene suture for scleral fixation without conjunctival dissection, and to describe related clinical outcomes associated with this approach.

Methods: In this study, we retrospectively reviewed 28 eyes from 27 patients that underwent scleral fixation of the intraocular lens (IOL) without conjunctival dissection using an adjustable single 8-0 polypropylene suture at the Beijing Tongren Eye Center between April 2018 and April 2019. For this surgical approach, a 23-gauge infusion cannula was set, after which two Hoffmann scleral pockets were created. Next, 8-0 polypropylene sutures were inserted into the eye guided by 10-0 polypropylene sutures of a long straight needle. The 8-0 suture was then used to fix the haptic IOs. Finally, these 8-0 polypropylene sutures were removed from the scleral pockets, and knots were tightened with the adjustable single suture. Primary outcomes included visual acuity and postoperative complication incidence.

Results: For this study, outcomes for 28 eyes from 27 patients (9 female, 18 male) were assessed. Patients had a mean age of 54 ± 15.11 years-old and were followed for an average of 10.18 ± 2.76 months postoperatively. Uncorrected visual acuity in these patients improved significantly from a preoperative value of 1.269 ± 0.464 logMAR to a 3-month postoperative value of 0.409 ± 0.413 logMAR (p = 0.000). The majority of postoperative complications in these patients were temporary and self-limiting, including corneal edema (35.71%), hypotony (14.29%), elevated intraocular pressure (28.58%), and mild hyphema (7.14%). No evidence of exposure or erosion of the trimmed suture end was detected in any patients. An ultrasound biomicroscope was able to readily detect the IOL and all sutures, and IOLs were found to be well-centered without any dislocation, tilting, or subluxation upon follow-up.

Conclusions: An adjustable single 8-0 polypropylene suture can reliably and effectively be used for scleral fixation without conjunctival dissection for the treatment of patients with aphakia or inadequate posterior capsule support. The novel procedure described herein may therefore be an effective means of minimizing the risk of suture-related complications in patients undergoing scleral-fixated IOL implantation.

Trial registration: Retrospective case series study, not applicable. NCT04476264 .

Keywords: 8–0 polypropylene suture; Adjustable; Transscleral suture fixation; Without conjunctival dissection.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1

Two scleral pockets without conjunctival dissection were created posteriorly from the two opposing incisions. a. A photo taken during surgery. b. A schematic of the modified procedure

Fig. 2

An 8–0 polypropylene suture was knotted with a 10–0 polypropylene suture. a. A photo taken during surgery. b. A schematic of the modified knotting procedure

Fig. 3

An overview of the insertion of an 8–0 polypropylene suture into the eye. a. Surgical photos demonstrating the presence of a 10–0 polypropylene suture with an 8–0 polypropylene suture of a long straight needle that was inserted into the eye on one side via passing through the conjunctiva and the full thickness of the scleral pocket at 1.5 mm posterior to the surgical limbus. b. A schematic of the procedure wherein the long straight needle was docked with a 27-gauge needle and externalized. c. A schematic of the procedure whereby an 8–0 polypropylene suture was inserted into the eye

Fig. 4

A schematic of the steps involved in suture retrieval from the scleral pockets

Fig. 5

The free end of the suture was wrapped two times, and the proximal end was grasped on both ends in order to tie the suture. a. A photo taken during surgery. b. A schematic of the modified procedure

Fig. 6

The IOL was well centered, with suture ends lying flat within the prepared scleral pockets. a. A photo taken during surgery. b. A schematic of the modified procedure

Fig. 7

UBM examination. a. Tunnels containing the sutures were clearly detected by UBM at two months postoperatively (blue arrow). b. IOL centration was readily detectable via UBM