Transscleral toric lens suturing in a patient with compensated glaucoma (clinical case)

Purpose. To evaluate the clinical efficacy of suturing subluxed toric IOL in a patient with compensated glaucoma. Material and methods. Patient B., 69 years old, diagnosis on the admission: «complicated cataract, open-angle advanced stabilized glaucoma with normal intraocular pressure, mixed astigmatism of both eyes», visual acuity of the left eye –0.1 sph +2.0 cyl –4.0 ax 170 = 0.3; OS – 19 mm Hg. Phacoemulsification of the left eye was performed, during which insolvency of the zinc ligaments was revealed, after which a capsular tension ring and RayOne toric lens sph +22.5 cyl +4.5 at an angle of 170° were implanted. The next day the vision was 0.6 sph –0.5 cyl –0.5 ax 170 = 0.7. After 5 days, the patient complained of decreased vision (VIS OS = 0.2 sph +2.0 cyl –6.0 ax 70 = 0.4), diplopia, pronounced «Halo» and «Glare» phenomena. Biomicroscopy revealed subluxation of the IOL upwards, rotation of toric IOL from 170° to 71°. Transscleral suturing of the lens to the episclera in accordance with the axis of astigmatism was performed. Results. The next day after toric IOL implantation ophthalmohypertension was detected, visual acuity was 0.2 n/w, 10 days later biomicroscopy showed stable toric lens position in 170° projection, refraction was sph –0.25 cyl –0.25 ax 51, visual acuity –0.7 n/w, tonometric intraocular pressure – 21 mm Hg. After 10 months – IOL position is stable, BCVA – 0.8, intraocular pressure – 20 mm Hg. Conclusion. This case illustrates a high probability of toric lens rotation and subluxation in case of lens ligament failure. This fact may contribute to the recommendation of primary suture fixation of the intraocular lens. Transscleral suturing of the IOL guarantees a stable position of the lens in the posterior chamber during long-term follow-up. Key words: cataract, glaucoma, phacoemulsification, intraocular lens, cataract extraction, toric intraocular lens