Method of transscleral suture fixation of a hydrophobic posterior chamber S-shaped intraocular lens

Objective. To demonstrate a method of transscleral suture fixation of a hydrophobic posterior chamber S-shaped intraocular lens (IOL) using a clinical case as an example. Method. Patient A., 75 years old, was admitted with complaints of low visual acuity in the left eye, episodic redness of the left eye. According to the patient, in 2010, phacoemulsification with implantation of an OU IOL was performed at his place of residence. In 2015, OU glaucoma was diagnosed by m/f, instillation of OU Sol.Timololi 0.5% 1 drop 2 times a day in both eyes. According to the examination data: visual acuity of the left eye (Visus) 0.05 sph +7.0 = 0.5, intraocular pressure (IOP) (pneumotonometry) 23 mm Hg. On biomicroscopy of the left eye: the cornea is transparent, the depth of the anterior chamber is wide, the iris is subatrophic, the pupil is round, 5 mm (medicinal mydriasis), pseudoexfoliation along the edge, iridodonesis, the vitreous cavity is destruction of the vitreous body, the IOL is visualized in the lower segment, not fixed to the membranes, the fundus: the optic disc is pale, the borders are clear, the ratio of the excavation to the disc is 0.7. M3 - without special features. According to the results of ultrasound ophthalmoscanning in B-mode, the IOL was determined in the posterior pole with the patient lying down, moving to the lower segment in the sitting position. According to the results of computer perimetry, concentric narrowing of the visual fields was determined. The diagnosis was: OS Aphakia. Dislocation of the IOL into the vitreous cavity. Primary open-angle glucocorticoid 2a. Pseudoexfoliation syndrome. As a result, a decision was made to perform surgical treatment - IOL removal and IOL implantation with suturing to the sclera. During the intervention, three 27G ports were installed at 2, 8 and 10 o'clock and 2 paracenteses were formed at 3, 9 o'clock and the main incision at 11 o'clock, 2.5 mm long. A dislocated IOL is visualized in the fundus, freely lying in the vitreous cavity, mobile. Central and peripheral vitrectomy was performed. Then, using straight endovitreal tweezers, the IOL was brought out to the pupil area and dislocated into the anterior chamber, previously filled with adhesive viscoelastic. Using scissors, the IOL was divided into 2 halves and removed through the main incision. Next, the IOL was ab externo sutured with non-absorbable 6/0 polypropylene suture material, and the remaining free posterior ends of the threads were coagulated using a thermal cautery to form a posterior fixing flange. Then the sutured IOL was implanted together with the remaining part of the 6-0 polypropylene thread after cutting off the needle into the posterior chamber through a standard cartridge. Then, using a 32 G curved injection needle, a primary scleral puncture was made 1.5 mm from the limbus into the posterior chamber of the eye at 60°, then one of the free anterior ends of the 6-0 polypropylene thread was inserted into the lumen of the guide needle using 25 G straight endovitreal tweezers and brought out of the eye, then the second free anterior end of the 6-0 polypropylene thread was brought out in the same way from the opposite side at 240°, then using two IOL tying tweezers, they were centered and fixing flanges were formed on the anterior free ends of the threads using a thermal cautery. Then, a revision of the vitreous cavity was performed. Sealing of corneal and scleral incisions without sutures. Results. The surgical intervention was performed without complications. In the postoperative period, standard anti-inflammatory and antibacterial therapy were prescribed. On the first day after the surgery: visual acuity of the left eye is 0.6 n/c, IOP of the left eye (pneumotonometry) is 15 mm Hg. The IOL was in a stable central position. According to the ultrasound ophthalmoscanning data in B-mode: the shells are adjacent. One month after the intervention: visual acuity of the left eye is 0.7 without correction, IOP is 17 mm Hg. Conclusions. The specified method of surgical treatment allows achieving a stable and centered position of the IOL and can be used to correct corneal astigmatism of a toric IOL in aphakia. Key words: polypropylene 6/0, transscleral fixation of the IOL, IOL dislocation