title: Sutureless scleral fixation of intraocular lenses: outcomes of two approaches. The 2014 Yasuo Tano Memorial Lecture.
abstract: OBJECTIVE
  We sought to assess the clinical outcomes and complications of two approaches to scleral fixation of intraocular lenses (IOLs): transconjunctival fixation through trocar cannulas and fixation using scleral tunnels created with a microvitreoretinal (MVR) blade.
  
  
  METHODS
  This retrospective chart review was comprised of 23 eyes that received scleral fixation of a three-piece IOL with concurrent pars plana vitrectomy between June 2012 and June 2014. Scleral fixation was performed either by transconjunctival fixation through trocar cannulas (cannula fixation) or by the creation of scleral tunnels using an MVR blade (tunnel fixation). The preoperative and postoperative corrected distance visual acuities (CDVA), spherical equivalents (SE), and complications were evaluated.
  
  
  RESULTS
  15 cannula fixations and 8 tunnel fixations were performed. Mean follow-up was 353 days (Range: 94 - 790 days). Fifteen IOLs were fixated 2 mm posterior to the limbus. Seven IOLs were fixated 1.5 mm posterior to the limbus, and one IOL was fixated 0.75 mm posterior to the limbus. Mean preoperative CDVA was logMAR 1.17 (Snellen 20/297), and mean postoperative CDVA was logMAR 0.37 (Snellen 20/47) (p <0.0001). At last follow-up, none of the IOLs have dislocated or subluxed and there has been no erosion of the subconjunctival haptics.
  
  
  CONCLUSIONS
  Scleral fixation of IOLs using trocar cannulas or scleral tunnels is an effective surgical option for the treatment of aphakia or IOL dislocation. Both techniques result in significant visual improvement with minimal postoperative complications.
authors.affiliation: Oakland University William Beaumont School of Medicine and Associated Retinal Consultants, 3535 West 13 Mile Road, Suite 344, Royal Oak, Michigan, 48073, USA.
authors.forename: Ashkan M
authors.initials: AM
authors.lastname: Abbey
authors.forename: Rehan M
authors.initials: RM
authors.lastname: Hussain
authors.forename: Ankoor R
authors.initials: AR
authors.lastname: Shah
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Faia
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Wolfe
authors.forename: George A
authors.initials: GA
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001036:Aphakia, Postcataract / Q000503:physiopathology / Q000601:surgery; D060437:Artificial Lens Implant Migration / Q000503:physiopathology / Q000601:surgery; D003228:Conjunctiva / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular / Q000009:adverse effects / Q000379:methods*; D008297:Male; D033401:Microscopy, Acoustic; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012590:Sclera / Q000601:surgery*; D013524:Surgical Flaps; D013536:Suture Techniques; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D055815:Young Adult