Sclera fixation intraocular lens with double-needle flanged technique in Marfan's syndrome

Abstract

Purpose: A majority of Marfan’s syndrome patients suffer from lens subluxation. Intraocular (IOL) implantation can be a challenge in this group of patient due to inadequate capsular support. Various operative techniques have been reported in literature, including in bag, sulcus fixation, scleral fixation, iris fixation, and their outcomes are equivocal. In this video, we describe the use of the flanged haptic IOL fixation technique, first published by Yamane, in a Marfan›s syndrome patient. This spares the need of scleral flap and suture fixation and hence their associated risks. Methods: A 34-year-old Chinese female with Marfan’s syndrome presented with superiorly subluxed lens. Lensectomy was first performed with irrigation and aspiration, and capsule remnants were removed with cutter via anterior approach. Limited anterior vitrectomy was then performed. A 3-piece intraocular lens (IOL) was injected into the eye and positioned above the iris. Haptics were externalized using the double-needle technique with 27G needles, as first described by Yamane in 2014. Low temperature cautery was then used to create the terminal bulb for fixation. Results: Post operatively, IOL was stable and centered, with manifest refraction of -1.50 / -0.50X120. Best corrected visual acuity (BCVA) was 0.8. Conclusions: Consistent with other experiences with the Yamane technique, our result has demonstrated that it is an attractive technique of lens fixation in Marfan patient lacking zonular support. This sutureless technique is safe, effective, and without risk specific to other conventional lens fixation techniques e.g. glaucoma in iris fixated IOL, corneal decompensation in anterior chamber fixated lOL.