Sutureless Scleral Fixated IOL: The “Catcher Pole” Technique
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Insertion of intraocular lens (IOL) in the capsular bag at the end of cataract surgery is considered the gold standard because the artificial lens is inserted in the physiological position of the natural lens and maintain a safe distance from ciliary body, iris and corneal endothelium. Three types of surgical options are available: anterior chamber IOL (ACIOL), iris-fixed IOL, or intrascleral-fixated IOL.

Twenty-one eyes of 19 patients who underwent “Catcher Pole” intrascleral IOL fixation between January 2019 and January 2020 were retrospectively evaluated. The inclusion criteria were: secondary implantation of intrascleral-fixated IOL for aphakia, subluxated or dislocated crystalline lens without sufficient capsular support and dislocated IOL. In three eyes a dislocated standard three-piece posterior chamber IOL (PCIOL) was rescued and intrascleral fixated; patients with previous additional surgical procedures were also included, such as primary pars plana vitrectomy (PPV), retinal detachment (RD), or proliferative diabetic retinopathy (PDR). The exclusion criteria were dense corneal leukoma or decompensated preoperative IOP above 26 mmHg, sclerokeratitis, and a postoperative follow-up duration of less than three months.

Two sclerotomy were performed on the three o’clock and nine o’clock meridian with an angulated 21 G stiletto knife, starting 1.5 mm posterior to the point corresponding to the iris root on the sclera. In twenty-one eyes of 19 patients, the mean preoperative BCVA was 0.61 logMAR units ± 0.05 SD, and the mean postoperative BCVA improved significantly to 0.18 logMAR units at three months ± 0.05 SD (P=0.002). The mean preoperative CCP was 610 μ ± 17 SD and the mean postoperative CCP 623 μ ± 16 SD, (P=0.73). In the subgroup that underwent IOL tilt evaluation, mean IOL tilt was 3.19± 2.01. The postoperative complications included iris capture of the IOL in one eye (4,7%) and transient ocular hypertension in two eyes (9,4%).

Baseline and postoperative characteristics are shown in Table 1. The haptics were well fixed and the IOL was centrally positioned in all 21 eyes of 19 patients (nine males, 10 females; mean age, 53.6±19.14 years old; range: 41–86years). The mean follow-up period was 10.32±2.67months (range: 6–14months). There were four aphakia, 10 dislocated PC IOLs, and seven subluxated crystalline lenses. All patients had associated ocular conditions, seven patients complicated ocular trauma (eight eyes), primary RD (two eyes) IOL dislocation (11 eyes). Some patients had complications before surgery (eg, iridodialysis, traumatic glaucoma). The decimal BCVA was measured and converted to logarithm of the minimum angle of resolution (logMAR) units for statistical analyses.
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