Reply: Techniques for scleral fixation of IOLs

Article Outline

• Copyright

In response to the first point of Singh and Stewart, it is true that 2 penetrations in the eye in the region of the ciliary body would predispose it to further hemorrhagic complications. However, we do not make 2 entries into the eye in the region of the ciliary sulcus; instead, we create a scleral route 1.5 mm from the posterior limit of the limbus. From there, we pass the blunt end of the double-armed 10-0 polyprolene (Prolene) suture.

As for the risk for endophthalmitis with our technique, the Prolene knot that serves as an anchor does not remain in the subconjunctiva but is buried deeply in the scleral incision. In addition, the loose ends of the suture are carefully cut next to the knot. Consequently, the suture will not be close to the conjunctiva or superficial.

When the scleral flap technique is used, the borders of the scleral incision are usually closed with a polyglycolic acid (Dexon) 6-0 suture. This suture often unties during the procedure, which is responsible for a great loss of time. Additionally, in up to 30% of cases, there is some degree of scleral flap atrophy after 10 years, with erosion and extrusion of the knot through the conjunctiva, which are more likely to cause bacterial contamination and endophthalmitis.

In more than 10 years of patient follow-up, we have not experienced any erosion of the sutures or case of endophthalmitis; thus, we believe our technique is safer than the scleral flap technique.