Long-term Outcomes of Secondary IOL Surgeries Using the Haptic Externalization Scleral Suture Technique

There are many surgical approaches for treating intraocular lens (IOL) dislocation, subluxation or situations when there is inadequate capsular support. This study evaluated the results of a single surgeon case series using the haptic externalization scleral suture (HESS) technique.

This was a retrospective, consecutive series of 223 patients with IOL fixation using the HESS technique. The same HESS technique was used in all patients. Patient demographics, surgical indications, ocular conditions, visual acuity (VA), and intraocular pressure (IOP) were recorded preoperatively. Postoperatively, VA, IOP, and complications were recorded at the 3-month, 1-year, 2-year, and final postoperative visits.

The 223 eyes 148 IOL repositioning surgeries, 54 IOL placements in aphakic patients, 12 IOL exchanges, and 9 lensectomies with IOL insertion. Median follow-up time was 3.39 years (91 days-22 years). There was a VA improvement from logMAR 1.14±0.05 (20/250-2) preoperatively to 0.48±0.04 (20/63+1) postoperatively (p<0.0001). The rate of IOL dislocation postoperatively requiring reoperation was 9/223(4%). Insertion of a new IOL was associated with a higher rate of postoperative corneal edema 9/75(12%) compared to IOL repositioning 5/148(3%) (p=0.012).

This large retrospective study highlights the success of the HESS technique for correcting IOL subluxation, dislocation, and aphakia and how repositioning of the IOL compared to IOL exchange helps to minimize the risk of corneal edema with robust VA improvement and relatively low reoperation rates.