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Lens implant with scleral pocket fixation / Glued IOL - A State of Sight #114

A scleral pocket fixation technique may be used to support an intraocular lens implant inside the eye. This operation may be also known as a glued IOL procedure, but the glue does not actually support the lens long term.

Watch this episode of A State of Sight with Isaac Porter, MD to learn more about this innovative procedure that has been popularized by Amar Agarwal, MD from India.

Welcome to A State of Sight, I’m Isaac Porter, and this is your update in ophthalmology and eye care from Raleigh. Today, I would like to explain the scleral fixation technique for lens implantation. Some people will call this a glued lens implant or glued IOL (intraocular lens) technique, but really the glue doesn’t help hold the lens in place, so I prefer the term scleral pocket fixation.

This is a new technique for putting in a lens implant when there isn’t the usual support inside the eye to hold the IOL. It was popularized by Dr. Amar Agarwal from India. He is a great surgeon and a great teacher who has helped to spread the word about this operation.

The way that this eye surgery works is by bringing the arms of the lens implant (the haptics) outside the eye and then securing them underneath pockets that we create in the sclera (the white wall of the eyeball). When we do this, we place the haptics exactly 180 degrees from each other. First, we bring out one haptic and tuck it into the pre made pocket and then repeat this with the second one.

This has been proven to be a very effective and safe technique and the lens looks really stable in this position inside the eye. It has advantages over some of the other techniques that can be used for secondary IOL implantation. This operation centers the lens very well and it also helps the IOL align in the proper orientation. It is important that the lens does not tilt, because this can cause trouble with vision.

After the lens is placed, glue is used to seal the pockets and to close the conjunctiva (the thin skin that covers surface of the eye). This glue generally dissolves over the first week or two and doesn’t contribute to the long term of the support of the lens.

Patients that may need this advanced eye operation could have had complicated cataract surgery where the lens couldn’t be put in at the time of surgery. Other patients who have had multiple operations including retina or glaucoma surgery could have complications with the lens implant inside their eye. In these cases, we may have to remove a lens implant and then place a new one with this technique.

The alternatives for this are an anterior chamber lens implant (ACIOL) that is put in front of the iris or a lens implant that is put in with sutures to the iris or the sclera. If you look back to A State of Sight episode #84, we cover these other operations in greater detail.

Since this a newer technique, we don’t have long term data on it, but it looks like it may be better than the other options, especially over time. With suture fixation, we are concerned about the sutures breaking in the future. If you have any questions about this new procedure, please post and we will be happy to answer them. Hopefully see you again soon on A State of Sight.