Management of severe intraocular lens tilt using transsulcus retention sutures

In eyes lacking capsular support, scleral-fixated intraocular lens (SF IOL) implantation serves as an effective solution. However, unintended SF IOL tilt can adversely affect patient outcomes. Drawing inspiration from the use of retention sutures in other surgical settings, we introduce a novel technique that uses transsulcus retention sutures (TSRSs) to treat severe SF IOL tilt in the use of 3 patients. The index case presented with uveitis–glaucoma–hyphema syndrome after double-flanged scleral fixation, while 2 other patients suffered from malfunction of the haptic–optic junction during flanged haptic scleral fixation. Severe optic tilt was noted in all 3 patients. Paired TSRSs were made by passing 9-0 polypropylene to and from the opposite scleral wall 3 mm apart in the sulcus plane, centered over the IOL optic, to either segregate the IOL optic from the posterior iris or to sandwich the IOL between 2 pairs of TSRS. Resolution of severe tilt and their sequelae were achieved in all cases.