Introduction:

Different techniques have been developed for intraocular lens (IOL) implantation in eyes with no capsular support, including anterior chamber IOLs and iris fixated IOLs. First described by Scharioth et al., the scleral tunnel insertion of the haptics of a three-piece IOL, resulting in a sutureless scleral fixation might be the best option for these patients. This technique was further modified by Prenner and Prasad et al.

Clinical Case:

A 78-year-old man with IOL-capsular bag luxation attended our department complaining of a decrease of visual acuity. As the model of the lens was a three-piece posterior chamber intraocular lens, a scleral-tunnel fixation of this lens was planned, in order not to change the lens and to avoid a corneal incision and secondary astigmatism. The technique started with a superior and inferior conjunctival flap dissection, followed by a 25 gauge (g) three-port PPV. Then, two parallel sclerotomies 2 mm from the limbus using a 25 g microvitreoretinal blade (MVRB) were performed. Besides two partial-thickness 4 mm scleral tunnels were created using a 20 g MVRB connecting with each sclerotomy. After releasing the IOL of the capsular bag, next step consisted of grasping each haptic at a distal point and pulling them through the sclerotomy into the scleral tunnel using a 25 g serrated forceps. Forceps had been previously bent in order to facilitate the maneuver. However, during haptic placement through the second tunnel, the prolene haptic disconnected from the lens. For this reason, IOL was removed through a 3-mm clear corneal incision, and a new three-piece posterior chamber intraocular lens was inserted. The maneuvers were repeated with the new lens and the conjunctiva is then closed with a single suture for each conjunctival flap.

Conclusion:

In eyes with a three-piece IOL luxation in vitreous cavity, the best option might be the sutureless insertion of the haptic of this lens in scleral tunnels. However, as it’s an old lens, the maneuver may cause the breakage of the haptic. Nevertheless, we think that the surgeon should continue with planned surgery by introducing a new three-piece posterior chamber IOL.

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