Intraoperative intraocular endoscopy in transscleral suture fixation of posterior chamber lenses: consequences for suture technique, implantation procedure, and choice of PCL design.

BACKGROUND: Transscleral suture fixation of posterior chamber lenses (PCLs) in the absence of capsular support causes minimal long-term alteration of the blood-aqueous barrier, if two requirements are fulfilled: 1) the transscleral suture has to penetrate exactly through the ciliary sulcus, and 2) the PCL haptics have to be directed into the sulcus and secured there.

METHODS: The surgical results of our standard techniques were controlled intraoperatively by means of intraocular endoscopy in every patient since May 1991. Different alterations were necessary to improve the incidence of sulcus penetration and implantation.

RESULTS: With our conventional suture techniques, the needle penetrated the ciliary processes in the majority of eyes. Best results were achieved by passing the needle from the outside into the eye before opening the globe. When the eye was already hypotonic, the ciliary processes tended to prolapse in front of the needle tip, resulting in pars plicata fixation. With perforating keratoplasty, passing the needle from the inside out by feeding one's way into the sulcus with the needle tip gave good results. Even correct needle penetration through the sulcus did not guarantee correct positioning of the PCL haptics in the sulcus.

CONCLUSIONS: Selecting a suitable PCL design and a new implantation technique which reduces the angle of PCL implantation, the rate of correctly positioned PCLs in transscleral suture fixation is increased considerably.