A Modified Knotless Transscleral Intraocular Lens Fixation Technology for Congenital Ectopia Lentis

Liyan Liu, Xuepei Li, Qianzhong Cao, Zhangkai Lian, Jieyi Wu, Guangming Jin, Danying Zheng, Liyan Liu, Xuepei Li, Qianzhong Cao, Zhangkai Lian, Jieyi Wu, Guangming Jin, Danying Zheng

Abstract

Introduction: This study aimed to compare modified knotless transscleral suture fixation of intraocular lens (IOL) with traditional transscleral suture fixation for adolescents and young patients with congenital ectopia lentis (CEL).

Methods: This retrospective cohort study included 49 patients with CEL (60 eyes) who underwent surgery at the Zhongshan Ophthalmic Center. Improvements based on knotless Z-suture fixation technique were made to form a modified knotless method, in which thicker 8-0 polypropylene sutures were used, and double parallel scleral grooves were constructed behind the limbus instead of triangular lamellar scleral flaps to cover suture stitches. Modified knotless transscleral fixation of IOL was conducted on 30 eyes, and the other 30 eyes underwent traditional transscleral fixation surgery. Pre- and postoperative best-corrected visual acuity (BCVA), refractive error, astigmatism, other ocular parameters, and complications were statistically analyzed.

Results: For patients in the modified knotless group, the mean cylindrical refractive error and astigmatism at 1 month and 3 months postoperative were lower (all P < 0.05), and the mean IOL tilt degree was smaller at 3 months postoperative (3.21° ± 2.13° vs. 5.65° ± 3.66°, P = 0.032). The incidence of suture exposure in the modified knotless group was also lower than in the controls (0 vs. 16.7%, P = 0.026). No group differences were observed in mean BCVA, spherical equivalent, or other ocular biometric parameters between groups.

Conclusion: Modified knotless technique was a valid method to achieve optimal IOL position and reduce postoperative astigmatism for adolescents and young patients with CEL. It effectively reduced the incidence of knot-related complications, greatly improved the postoperative comfort, and achieved aesthetic benefits.

Keywords: Congenital ectopia lentis; IOL; Knotless; Transscleral suture fixation.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Schematics of modified knotless transscleral fixation of the PCIOL. a Two parallel scleral grooves are constructed perpendicular to the limbus at 4 and 10 o’clock, with a length of 3 mm, a width of 3 mm, and a depth of one-half (around 0.3–0.4 mm) the thickness of the sclera. Beneath the scleral surface, the width at their base was 2.5 mm, forming a wedge-shaped section. A corneal incision is made at 12 o’clock. b 8–0 polypropylene sutures are tied to the haptics of the IOL, and the suture is tightened by equal force with both hands and adjusted to center the IOL optic. c Z-shaped suturing is performed along the scleral grooves on both sides, moving back and forth five times. The thread is ultimately cut, without leaving knots, and buried in the scleral grooves
Fig. 2
Fig. 2
Inflammatory congestion on knots or embedding suture of two patients from different groups 1 week after surgery. a From traditional group, b from modified knotless group; the inflammatory congestion on the knot was heavier than that on the embedding suture
Fig. 3
Fig. 3
IOL positions of two patients from different groups: a, c from traditional group; b, d from modified knotless group; a, b captured under the slip-lamp microscope; c, d obtained from the Pentacam. IOL position of patients from the modified knotless group was less inclined

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