Sutured Scleral-Fixated Intraocular Lens in Posterior Capsular Rent



Intraocular lens (IOL) implantation in cases lacking sufficient capsular support is challenging to the anterior segment surgeon. If the anterior capsule is intact and with no tears at the capsulorhexis margin, then a sulcus fixation is preferred by most surgeons; however, square-edged one-piece hydrophobic lenses should be avoided. If there is no capsular support to ascertain stable fixation, then other alternatives are used, such as scleral fixation of a three-piece IOL, either by suturing or by placing the haptics in a scleral tunnel, iris fixation using sutures or iris claw lenses, and anterior chamber angle supported IOLs.


Suture Fixation Anterior Chamber Angle Scleral Flap Scleral Tunnel Suture Breakage 

Supplementary material

Video 25.1

(WMV 130436 kb)


  1. 1.
    Malbran ES, Malbran Jr E, Negri I. Lens guide suture for transport and fixation in secondary IOL implantation after intracapsular extraction. Int Ophthalmol. 1986;9:151–60.CrossRefPubMedGoogle Scholar
  2. 2.
    Lewis JS. Ab externo sulcus fixation. Ophthalmic Surg. 1991;22:692–5.PubMedGoogle Scholar
  3. 3.
    Fass ON, Herman WK. Four-point suture scleral fixation of a hydrophilic acrylic IOL in aphakic eyes with insufficient capsule support. J Cataract Refract Surg. 2010;36:991–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Chakrabarti A, Gandhi RK, Chakrabarti M. Ab externo 4-point scleral fixation of posterior chamber intraocular lenses. J Cataract Refract Surg. 1999;25:420–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Baykara M, Avci R. Prevention of suture knot exposure in posterior chamber intraocular lens implantation by 4-point scleral fixation technique. Ophthalmic Surg Lasers Imaging. 2004;35:379–82.PubMedGoogle Scholar
  6. 6.
    Jürgens I, Lillo J, Buil JA, Castilla M. Endoscope-assisted transscleral suture fixation of intraocular lenses. J Cataract Refract Surg. 1996;22:879–81.CrossRefPubMedGoogle Scholar
  7. 7.
    Olsen TW, Pribila JT. Pars plana vitrectomy with endoscope-guided sutured posterior chamber intraocular lens implantation in children and adults. Am J Ophthalmol. 2011;151:287–96.CrossRefPubMedGoogle Scholar
  8. 8.
    Por YM, Lavin MJ. Techniques of intraocular lens suspension in the absence of capsular/zonular support. Surv Ophthalmol. 2005;50:429–62.CrossRefPubMedGoogle Scholar
  9. 9.
    Hoffman RS, Fine IH, Packer M, Rozenberg I. Scleral fixation using suture retrieval through a scleral tunnel. J Cataract Refract Surg. 2006;32:1259–63.CrossRefPubMedGoogle Scholar
  10. 10.
    Hoffman RS, Fine IH, Packer M. Scleral fixation without conjunctival dissection. J Cataract Refract Surg. 2006;32:1907–12.CrossRefPubMedGoogle Scholar
  11. 11.
    Koytak A, Sari ES, Altinisik M. Scleral fixation underneath an intact conjunctiva. J Refract Surg. 2013;29:220–3.CrossRefPubMedGoogle Scholar
  12. 12.
    Szurman P, Petermeier K, Aisenbrey S, Spitzer MS, Jaissle GB. Z-suture: a new knotless technique for transscleral suture fixation of intraocular implants. Br J Ophthalmol. 2010;94:167–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Oshika T. Transscleral suture fixation of a subluxated posterior chamber lens within the capsular bag. J Cataract Refract Surg. 1997;23:1421–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Ma KT, Kang SY, Shin JY, et al. Modified Siepser sliding knot technique for scleral fixation of subluxated posterior chamber intraocular lens. J Cataract Refract Surg. 2010;36:6–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Virata SR, Holekamp NM, Meredith TA. “Luggage-tag” suture fixation of partially dislocated intraocular lenses. Ophthalmic Surg Lasers. 2001;32:346–8.PubMedGoogle Scholar
  16. 16.
    Domingues M, Brito P, Falcão M, Monteiro T, Falcão-Reis F. Cupid fixation for repositioning subluxated intraocular lens. J Cataract Refract Surg. 2011;37:1571–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Buckley EG. Hanging by a thread: the long-term efficacy and safety of transscleral sutured intraocular lenses in children (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2007;105:294–311.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Price MO, Price Jr FW, Werner L, Berlie C, Mamalis N. Late dislocation of scleral-sutured posterior chamber intraocular lenses. J Cataract Refract Surg. 2005;31:1320–6.CrossRefPubMedGoogle Scholar
  19. 19.
    McAllister AS, Hirst LW. Visual outcomes and complications of scleral-fixated posterior chamber intraocular lenses. J Cataract Refract Surg. 2011;37:1263–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Asadi R, Kheirkhah A. Long-term results of scleral fixation of posterior chamber intraocular lenses in children. Ophthalmology. 2008;115:67–72.CrossRefPubMedGoogle Scholar
  21. 21.
    Assia EI, Nemet A, Sachs D. Bilateral spontaneous subluxaion of scleral fixated intraocular lenses. J Cat Refract Surg. 2002;28:2214–6.CrossRefGoogle Scholar
  22. 22.
    Holt DG, Young J, Stagg B, Ambati BK. Anterior chamber intraocular lens, sutured posterior chamber intraocular lens, or glued intraocular lens: where do we stand? Curr Opin Ophthalmol. 2012;23:62–7.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Ram J, Gupta N, Chaudhary M, Verma N. A new surgical technique using steel suture for trans-scleral fixation of posterior chamber intraocular lenses. Indian J Ophthalmol. 2013;61:749–51.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Heilskov T, Joondeph BC, Olsen KR, Blankenship GW. Late endophthalmitis after transscleral fixation of a posterior chamber intraocular lens. Arch Ophthalmol. 1989;107:1427.CrossRefPubMedGoogle Scholar
  25. 25.
    Solomon K, Gussler JR, Gussler C, et al. Incidence and management of complications of transsclerally sutured posterior chamber lenses. J Cataract Refract Surg. 1993;19:488–93.CrossRefPubMedGoogle Scholar
  26. 26.
    McCluskey P, Harrisberg B. Long-term results using scleralfixated posterior chamber intraocular lenses. J Cataract Refract Surg. 1994;20:34–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Michaeli A, Assia EI. Scleral and iris fixation of posterior chamber lenses in the absence of capsular support. Curr Opin Ophthalmol. 2005;16:57–60.CrossRefPubMedGoogle Scholar
  28. 28.
    Assia EI, Rosen E, Ta G, Crystal-Shalit O. Four-point PC-IOL fixation in the absence of capsular support. Presented at the XXVII Meeting of the European Society of Cataract & Refractive Surgeons (ESCRS) Sept, 2009, Barcelona, Spain.Google Scholar

Copyright information

© Springer India 2017

Authors and Affiliations

  1. 1.Department of OphthalmologyMeir Medical Center and Eit Tal Eye Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv UniversityKfar SabaIsrael

Personalised recommendations