Advantages:

Posterior dislocation of an intraocular lens is an uncommon but serious complication of cataract surgery. This may occur intra-operatively or postoperatively due to large posterior capsular defects, weak zonules or trauma. In case of inadequate capsular support these lenses are repositioned by suture fixation or are removed and replaced by an anterior chamber IOL. Suturing of a dislocated IOL to the sclera is technically demanding resulting in an increased number of intra-operative and post-operative complications. In addition, many suture related complications like knot exposure or broken suture can occur. Tilting of suture fixated IOL can also happen causing increased astigmatism. Scleral fixation of the IOL using fibrin glue is a simple technique which avoids all the above complications besides giving better post operative visual results. The advantages of repositioning of IOL by this technique, it avoids intraoperative fluctuation in intra-ocular pressure during removal of lens. Also, it does not cause knot exposure or broken/loose sutures.

Methods:

Retrospective interventional case series of 10 eyes that underwent repositioning of the dislocated IOL using glue assisted sclera fixation. None of the above eyes had any capsular support. Standard 3 port pars plan Vitrectomy was performed in all eyes. PVD was induced when needed and IOL was separated of all vitreous adhesions. Vitreous was also removed from anterior chamber and the pars plana region. Partial thickness sclera flaps were made at 3 o‘clock and 9 o‘clock. A sclerotomy was done under the flap 1.5 mm behind the limbus on both sides. Using a 23 gauge forceps the haptics of the IOL were brought out on both sides. The IOL was rotated to make it central. Small sclera pockets were dissected at the edge of the flaps and the ends of the haptics were buried in those pockets. Glue was applied in the flap region to close the pockets, sclerotomy and the flap.

Safety:

The follow up was done at 1 day, 1 week, 2 weeks, 6 weeks and 3 months post-operatively. All but one of the IOLs was adequately positioned. None of the patients had intra-operative/post-operative surgical complications.

Conclusion:

Glue assisted sclera fixation is a safe and effective way of repositioning of dislocated IOLs. This technique can also be combined with sutureless vitrectomies for faster rehabilitation of patients.