Implantable Polypropylene Capsular Hook(s) for Managing Subluxated Lenses: A Prospective Study.

PURPOSE: To report the clinical outcomes of intrascleral fixation of implantable capsular hooks for managing subluxated lenses.

DESIGN: Prospective, noncomparative, interventional case series.

METHODS: Patients with subluxated lenses who underwent in-the-bag intraocular lens (IOL) implantation assisted by capsular tension ring and implantable capsular hook(s) made of 7-0 polypropylene sutures were included. The main postoperative outcome measure was IOL position, including IOL decentration, tilt, postoperative anterior chamber depth, and the distance between IOL and iris. Secondary postoperative outcomes included best-corrected visual acuity, spherical equivalent, corneal endothelial cell density, intraocular pressure, and complications.

RESULTS: Seventy-four eyes of 74 patients were enrolled, with a mean follow-up of 13.2 ± 8.9 months (range: 6-36 months). The IOL position remained stable throughout the follow-up period, with a mean IOL decentration of 0.31 ± 0.24 mm and a mean tilt of 1.83 ± 1.35° at the final follow-up visit. Both postoperative anterior chamber depth and the distance between IOL and iris remained stable, with values of 3.91 ± 0.33 mm and 0.65 ± 0.26 mm at the final follow-up visit, respectively. The mean best-corrected visual acuity improved from 0.75 ± 0.73 logarithm of the minimum angle of resolution (Snellen 20/112) preoperatively to 0.24 ± 0.28 logarithm of the minimum angle of resolution (Snellen 20/35) at the final follow-up visit (P < .05). The mean spherical equivalent was -2.37 ± 4.68 D preoperatively and -1.09 ± 1.33 D at the final follow-up visit (P < .05). The mean endothelial cell density decreased from 2577.64 ± 486.10 cells/mm2 preoperatively to 2171.31 ± 707.23 cells/mm2 at the final follow-up visit with a mean loss of 14.70 ± 14.60% (P < .05). The intraoperative complication was transient mild bleeding during penetration of the scleral wall (n = 4, 5.4%). Postoperative complications included intraocular pressure elevation (n = 9, 12.2%), hypotony (n = 2, 2.7%), grade 2 anterior chamber cells (n = 2, 2.7%), retinal detachment (n = 1, 1.4%), cystoid macular edema (n = 1, 1.4%), and posterior capsule opacification (n = 1, 1.4%).

CONCLUSIONS: Intrascleral fixation of implantable capsular hooks enables in-the-bag IOL implantation in eyes with subluxated lenses and represents a feasible, stable, and safe approach.