Advantages:

Intrascleral haptic fixation [ISHF] avoids the complications of using sutures in scleral fixated intraocular lens (IOL), including the breakdown of sutures causing dislocation of IOL, suture erosions and obviates the need to create scleral flaps. In cases of posterior dislocated IOL complex, original 3-pieces foldable IOL can be reused. For cases that required IOL exchange or correction of aphakia, it can be inserted through a 3 mm small corneal incision with good centration. This method also has the potential for scleral fixation of other premium IOLs like multifocal IOLs.

Methods:

Alcon Acrysoft MA60AC IOL was used in all cases. The IOLs were introduced into the eyes either by folding forceps or injectors and some were IOL rescue cases in which the dislocated IOLs were brought into the scleral tunnels directly. After limited conjunctival peritomy, 2 sclerotomies were made by using 23 gauge needle at 1.5-2.0 mm post limbus, which were 180 degree opposite to each other. Then a scleral tunnel was fashioned by using an angled 23 gauge needle parallel to the limbus starting from the aforementioned 23 gauge sclerotomies with a length of 2-3 mm. The directions of the 2 scleral tunnels should be in the directions corresponding to the inverted S haptics directions of the IOL. The haptics of the IOL were brought through the 23 gauge sclerotomies by the straight 25 gauge Scharioth forceps and were introduced into the scleral tunnels by the curved 25 gauge Scharioth forceps. No glue was used in all cases. This procedure was mostly combined with posterior vitrectomy. We can also use anterior chamber maintainer.

Effectiveness / Safety:

A consecutive case series of ISHF was performed from 1 April 2012 to 31 Mar 2013. Total 20 eyes were included and 18 cases were combined with posterior segment procedures. All of them had improved postoperative vision. There were no cases of IOL dislocation, new occurrence of corneal decompensation or endophthalmitis. One of the cases needs IOL exchange because of flopping iris with pigment dispersion. The technique is a safe and effective method to fixate IOL that without adequate capsular support. However, studies on long-term results and complications are warranted.