Sutured IOL's to replace cataracts By William Goldstein on March 28, 2018

Intraocular lens implantation is an important procedure when it comes to laser cataract surgery. Essentially,
cataract is a cloudy and dense formation that develops on the natural lens of the eye, thus
impairing vision. Laser cataract surgery entails removing the part of the natural lens that is affected by
the cataract. Once the natural lens is removed, an intraocular lens is implanted within the lens
membrane to replace the natural lens and help the patient to see better.

What is scleral-fixated IOLs?

There are several different types of intraocular lens implants or IOLs, and one of them is called
scleral-fixated IOL.

Scleral IOLs are recommended in situations where the cornea is transplanted or in cases where
the iris offers insufficient support. Scleral fixation is also used in situations where the membrane
surrounding the lens is too weak or damaged. The IOL is sutured to the sclera of the eye. The sclera is a protective outer layer that is composed mainly of collagen and elastic fiber.

The procedure

While scleral-fixation appears to be a relatively simple procedure, it comes with certain
complications. The IOLs are implanted with the help of delicate sutures. It is fixed to two
different points on the sclera, namely the conjunctiva and the Tenon's capsule. The conjunctiva is the white part of the eye and it protects the sclera. The Tenon's capsule is a
thin membrance that covers the eyeball.

The sutures used to hold the IOL in place is relatively simply. There are, however, increased chances of complications such as conjunctival erosion. This is why scleral IOLs have to be sutured with precision and care. Another procedure for scleral fixation involves covering the lens with scleral flaps. The procedure starts with fashioning triangular shaped flaps. The flap is then positioned above the sclera and secured using a knot thus eliminating the need for sutures. Again, if the flap is too thin, it can tear or puncture. That is why the Flap needs to be designed with utmost precision.

Compared to the sutured scleral technique, the scleral flap is the most effective method of intraocular lens implantation. The only hitch is in designing the flap but it can be performed without much ado. Complications with this procedure are far less than that reported in cases where sutures are used. Results also show that the technique of using flaps allowed for better recovery post-op. The absence of sutures reduces irritation due to external exposure as well.

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Dr. William S. Goldstein

Laser Eye Care Center

William S. Goldstein, MD, has been practicing laser eye surgery since 1991. He was one of the first doctors to offer advanced eye care in all of Michigan and is a member of several prestigious organizations: 

  • American Board of Ophthalmology
  • American Academy of Ophthalmology
  • American Society of Cataract and Refractive Surgeons

If you are ready to enhance your vision, call our office at (586) 323-2020 or request a consultation online.

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