Scleral fixation of an intraocular lens in the absence of capsular support

Abstract Purpose: To ascertain the best surgical technique for fixating an intraocular lens (IOL) in the posterior chamber in the absence of capsular support. Setting: From the Institute of Ophthalmology, Pavia University, Pavia, Italy. Methods: Using the SFVT System, the phases of IOL fixation were evaluated in cadaver eyes. In addition, IOLs were implanted in the posterior chamber in 340 eyes of patients without capsular support. One of several IOL fixation methods was used; IOL power was calculated using the same parameters as when the lens is positioned in the sulcus. Mean follow-up was 3.5 years (range 2 months to 5 years). Results: Intraocular lens placement was accurate only when the loops were positioned in the sulcus, with the best approach being internal with suspension sutures placed at 3 and 9 o'clock. In most cases, refractive results were good; 152 eyes were within ±1.00 diopter of the predicted value. Conclusion: In eyes without capsular support, IOL implantation in the sulcus was possible only when sutures were placed exactly through the sulcus. An internal approach using suspension sutures at 3 and 9 o'clock gave the best results.