Prevention of Suture Knot Exposure in Posterior Chamber Intraocular Lens Implantation by 4-Point Scleral Fixation Technique

* BACKGROUND AND OBJECTIVE: The results and complications of posterior chamber intraocular lens (IOL) implantation by a 4-point scierai fixation technique are described. * PATIENTS AND METHODS: Fifty eyes of 47 patients who underwent scleral-fixated IOL implantation were retrospectively evaluated. Twenty-one (42%) eyes had a history of trauma and 29 (58%) eyes had previously undergone cataract surgery. In all cases, IOL implantation by 4-point scierai fixation was performed and the knots of fixation sutures were rotated and buried in the globe. The IOL position was adjusted by suture rotation for best centration. * RESULTS: The mean follow-up time was 7 ± 4 months. Four (8%) eyes had minimal corneal edema preoperatively. Cystoid macular edema was noted in 2 (6.8%) eyes in the cataract surgery group and 8 (38%) eyes in the posttraumatic group. Two (9.5%) eyes in the posttraumatic group had atrophie macular changes and 1 (4.7%) had cornea! scarring, which impaired vision. No complications such as knot exposure, tilting of the IOL, decentralization, or endophthalmitis were noted postoperatively. Postoperative mean corrected visual acuity was 0.4 ± 0.3 in the posttraumatic group and 0.4 ± 0.2 in the cataract surgery group. * CONCLUSION: The 4-point scierai fixation technique resulted in no serious postoperative complications such as suture exposure and endophthalmitis. Because the knot can be rotated and buried in the globe, knot exposure is less likely to occur. This procedure is more effective than other techniques regarding IOL centralization. [Ophthalmic Surg Lasers Imaging 2004;35:379-382.]