L-Suture Technique for Transscleral Intraocular Lens Fixation

Purpose: To report the clinical outcomes of a modified suture technique used for transscleral intraocular lens (IOL) fixation. Methods: This study enrolled patients with aphakia, dislocated IOL, or crystalline lens luxation. All eyes underwent transscleral IOL fixation using the L-suture technique. The maximum tensile strength of the L-suture fixation was evaluated in vitro and compared to the Z-suture technique. Outcome measures included best-corrected visual acuity (BCVA), corneal endothelial cell density (ECD), IOL tilt, and postoperative complications. Results: This case series included 35 eyes of 33 consecutive patients. The mean follow-up time was 21±7 months. The mean BCVA improved from 0.25±0.29 logMAR (Snellen 20/36) at baseline to 0.09±0.13 logMAR (Snellen 20/25) at the final follow-up ( P =0.001). At the last visit, corneal endothelial cell count decreased by 7.2% ( P <0.05), and the mean tilt angle of IOL was 2.91±2.21 degrees. Common intraoperative complications included subconjunctival hemorrhage occurred (5/35; 14.3%) and edematous conjunctiva (3/35; 8.6%). Postoperative complications included IOL iris capture (4/35; 11.4%) and transient ocular hypertension (4/35; 11.4%). In ex vivo testing, the maximum tensile strength of the L-suture fixation was higher than that of the Z-suture fixation ( P <0.01). Conclusion: The L-suture technique provides a satisfying postoperative IOL position with robust fixation while minimizing invasiveness.