Twenty-Seven-Gauge Needle-Assisted Technique for Repositioning of Late Luxated or Subluxated Capsular Bag-Intraocular Lens Complex: Inverted Scleral Tunnel for Flanged Polypropylene Suture Technique

Abstract Purpose: To describe a minimally invasive and atraumatic technique for managing a polypropylene suture-assisted scleral fixation intraocular lens-capsular bag complex (IOL-CBC) or artificial iris-intraocular lens complex for repositioning late luxated or subluxated intraocular lens-capsular bags and artificial iris-intraocular lens complexes. Methods: This was a retrospective, single-center and observational study. We evaluated 11 patients, including 10 with capsular bag-lens complex subluxation or luxation into the vitreous cavity and one with an aniridia-intraocular lens complex. The patients were operated on following standard aseptic protocols, including retrobulbar anesthesia, scleral marking, and fixation of IOL-CBC haptics using a novel 6-0 polypropylene suture technique, followed by cauterization and intrascleral burrying with polyglactin sutures. Results: This study analyzed 11 patients with dislocated or dropped IOL-CBC. The median age of the patients was 67 (44-78) years, with a median follow-up period of 10 (4-16) months. Among them, 8 (72%) were male and 3 (27%) were female. Conjunctival peritomy was performed in 4 (36%) patients, while opening was not required in 7 (63%) patients. Predominantly, preoperative diagnoses indicated 7 (63%) patients with dislocated IOL-CBC, primarily involving three-piece lenses. The IOL-CBCs were centralized in all patients, and optical coherence tomography confirmed accurate suture positioning within the sclera. No suture-related complications were detected throughout the follow-up period. No vision-threatening complications were reported during the postoperative follow-up. Conclusions: Our technique offers a simple, effective solution for treating decentralized or dislocated IOL-bag complexes, eliminating the need for complex interventions such as large corneal wounds, scleral flaps, IOL exchange, or IOL externalization.