So why does the world need another technique for the surgical management of complex intraocular lens (IOL) scenarios? Perhaps we don’t, but tailoring our surgical approaches to specific clinical scenarios makes intellectual sense… So here is another one:
In the March 15, 2017 edition of RETINA, our group presented a novel surgical approach for patients with an unmet need. Eyes that require an IOL and have insufficient capsular support can be managed by a host of techniques. However, after trauma, eyes that have iridodonesis and/or an irregular dilated pupil present unique challenges. Secondary angle recession, which is often present, makes placement of an ACIOL less attractive. Traumatic iridodonesis may result in recurrent hemorrhage secondary to rubbing of the mobile iris against a typical PCIOL fixated to the sclera with or without sutures. An abnormal or dilated pupil may result in visual dysfunction if the patient sees around the IOL optic.
To manage this specific scenario, the new approach was developed. This procedure allows for Gore-Tex suture fixation of a CZ70BD IOL using a cow hitch knot. Gore-Tex suture does not degrade over time, the large optic (7mm) limits iris mobility and visualization around a smaller optic, and the cow-hitch allows for four-point fixation.
We have one-year outcomes on a large series at this point, and things are looking excellent to date. With surgery though, the jury remains out for years down the road, when we can see if this is a viable long-term approach. For now, this seems to be a well tolerated way of managing this select patient population.
Jonathan Prenner, M.D.
