Outcomes of Transscleral Sulcus Fixation of Intraocular Lenses through a 2.4-mm Incision with an Injector System: 1-Year Follow-Up Akiko Masai, MD, Tomoichiro.

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Outcomes of Transscleral Sulcus Fixation of Intraocular Lenses through a 2.4-mm Incision with an Injector System: 1-Year Follow-Up Akiko Masai, MD, Tomoichiro Ogawa, MD Takuya Shiba, MD, Hiroshi Tsuneoka, MD Department of Ophthalmology The Jikei University School of Medicine Tokyo, Japan Ｎo financial interest

Objective To evaluate postoperative outcomes of scleral-sutured ciliary sulcus fixation of foldable intraocular lens (IOL) through a 2.4-mm incision

Methods Subjects: 9 eyes (9 patients) Lens subluxation : 1 eye Aphakia : 5 eyes IOL dislocation : 3 eyes ⇒the lenses were divided in the eye and extracted through 2.4mm incision. Variables examined Best-corrected visual acuity (BCVA) Before and after surgery (1 week; 1, 3, 6, 12 months) Surgically induced astigmatism (SIA) (Cravy method) After surgery (1 week; 1, 3, 6, 12 months) Endothelial cell density Before and after surgery

Surgical Technique Preparation for IOL setting of PC-9 hooking 10-0 double polypropylene thread (PC-9, Alcon) inserted through cartridge (E1, HOYA) PC-9 looped around haptics of IOL (VA70AD or VA65BB, HOYA) with cow-hitch knot IOL cartridge PC9 cow hitch knot

Surgical Technique Scleral pockets created at the 2 and 8-o’clock positions Anterior vitrectomy performed 2.4-mm scleral corneal incision created at 12-o’clock position IOL setting: IOL and hooked PC-9 loaded into cartridge IOL inserted through incision with injector (ISH-001, HOYA), leaving opposite haptics out of the eye PC-9 looped around haptics IOL fixed to ciliary sulcus

Result 1 Early improvement in BCVA maintained for 1 year BCVA (LogMAR)

Result 2 Surgically induced astigmatism was minimal SIA (D)

Endothelial cell density Result ３ Mean endothelial cell density reduced 9.80% Endothelial cell density 2053 1853 pre post (/mm2) 2000 1000

Conclusion Sulcus fixation of an IOL by the injector reduced the number of intraocular actions because of the preoperative preparation for IOL setting of PC-9 hooking. allowed IOL insertion through a small incision. With this technique, visual acuity improved early postoperatively and was maintained for 1 year