Managing Iop in Glaucoma: A Case Study of Subluxated Iol Fixation Using the Double Belt Loop Technique

Introduction Glaucoma is a chronic progressive optic neuropathy with a prevalence of 2.93% in European adults [1]. Subluxated intraocular lens (IOL), which can be managed using The Double Belt loop technique based on scleral fixation [2], can negatively affect intraocular pressure (IOP) [3]. Individualized patient approach is the most important aspect of successful glaucoma treatment [4]. Case Presentation An 89-year-old male with open-angle glaucoma presented with increased IOP, despite maximum conservative treatment. At the time he had already undergone phacoemulsification with an IOL and capsule tension ring (CTR) implantation in his left eye. The patient had been signed up for trabeculotomy which went without complications and IOP was controlled. After 8 months the patient returned complaining of blurry left eye vision and was diagnosed with IOL, CTR and capsule complex dislocation downwards. The complex was fixated using surgical Double Belt loop technique [2]. During this technique 6-0 polypropylene suture is passed through sclera as a loop around IOL haptic and the final flanges at the ends of the suture are formed. However, this case had a challenging aspect because IOL was rotated to 6 and 12 o'clock and two flanges were in the same area as the trabeculotomy bleb. The procedure had no postoperative complications, allowing the vision and IOP to improve and these results have remained unchanged up to this day (1 year postoperatively). Discussion IOL dislocation affects high IOP through several mechanisms [5], and has an incidence of up to 2% [6]. The Double Belt loop technique for IOL fixation involves creating scleral tunnels with 30G needles, forming two loops around the IOL haptics and externalizing them through the tunnels into sclera, securing them with flanges at the ends of suture, therefore stabilizing the IOL-capsule complex [2]. Fixated flanges gravely increased the risk of filtering bleb fibrosis and scarring, reducing aqueous humor drainage [7, 8]. Therefore, careful monitoring of IOP is an important part of postoperative complication prevention [8].