Inverted tunnel scleral fixation technique for dropped intraocular lens complex: the double-flanged suture method

The aim of this study is to describe a minimally invasive and atraumatic technique for managing the polypropylene suture-assisted scleral fixation of intraocular lens-capsular bag complex or artificial iris-intraocular lens complex for repositioning late luxated or subluxated intraocular lens-capsular bags and artificial iris-intraocular lens complexes.

In this retrospective and observational study, we evaluated 11 patients, including 10 patients with capsular bag-intraocular lens complex subluxation or luxation into the vitreous cavity and 1 patient with an aniridia-intraocular lens complex. A single senior surgeon performed the procedures. After anesthesia, a 4 × 4 mm conjunctival peritomy was created, and a 6-0 polypropylene suture was passed through the sclera marked 2.0 mm posterior to the limbus. The suture ends were cauterized into a flange under 0.5 mm and inserted inversely into a scleral tunnel, concealed within a 2-mm scleral tunnel to ensure secure intraocular lens positioning.

We analyzed 11 patients with dislocated or dropped capsular bag-intraocular lens complexes. The patients' median age was 67 (range 44-78) years, with a median follow-up of 10 (range: 4-16) months. There were 8 (72%) men and 3 (27%) women. Conjunctival peritomy was performed in 4 (36%) patients. Predominantly, preoperative diagnoses indicated 7 (63%) patients with dislocated capsular bag-intraocular lens complexes. The capsular bag-intraocular lens complexes were centralized in all patients, and optical coherence tomography confirmed accurate suture positioning within the sclera. No suture-related complications were observed throughout the follow-up period, and no vision-threatening complications were reported during the postoperative follow-up.

Our technique provides a simple, effective solution for treating decentralized or dislocated capsular bag-intraocular lens complexes, eliminating the need for complex interventions such as large corneal wounds, scleral flaps, intraocular lens exchange, and intraocular lens externalization.