Ultrasound Biomicroscopy in scleral fixation using Gore-Tex suture of a subluxated PCIOL.

Abstract

Introduction: The aim of our study was to assess the outcome of Gore-Tex sutures in minimally invasive scleral fixation of subluxated posterior chamber intraocular lenses (PCIOLs) and to demonstrate a method for validating the lens position.

Methods: Retrospective study of patients who underwent lasso in-the-bag scleral fixation of a subluxated PCIOL using the snare technique with Gore-Tex suture from 2019 to 2021 in a single tertiary medical center. Functional outcome was analyzed by clinical assessment, and anatomical outcome, by ultrasound biomicroscopy (UBM).

Results: 18 eyes were included . Mean duration of follow-up was 140 days (range 23-659), and median time from PCIOL implantation to fixation was 8.5 years (IQR 6.25-10.75). All patients had ocular comorbidities, mainly glaucoma (n=6) and pseudoexfoliation syndrome (n=5). Best corrected visual acuity improved from a median of 6/30 (0.7 logMAR) to a median of 6/12 (0.35 logMAR) (P=0.06); postoperative astigmatism measured 0.91±2.19 diopters. UBM demonstrated well-balanced PCIOL fixation with no difference between the horizontal and vertical tilt measurements (P=0.84;P=0.94;P=0.62;P=0.085). The fixated PCIOL showed < 10% decentration in reference to the visual axis. There was a high negative correlation between BCVA improvement and residual lens tilt (r=-0.76, P=0.037). Postoperative complications included transient ocular hypertension (n=3), corneal decompensation with subsequent keratoplasty (n=3), temporary hypotony (n=2), cystoid macular edema (n=1), suture exposure (n=1) and endophthalmitis(n=1).

Conclusions: Subluxated PCIOLs are amenable to treatment with minimally invasive fixation using Gore-Tex suture with good anatomic outcomes. UBM image analysis may serve as a valuable method for assessing PCIOL position following scleral fixation.