LAUSR

Intrascleral Fixation of Implantable Polypropylene Capsular Hook(s) to Reconstruct Capsular Support for Out-of-the-Bag Intraocular Lens Fixation in Vitrectomized Eyes When in-the-bag intraocular lens (IOL) implantation is impractical because of capsular fibrosis and (or) absence of posterior lens capsule in aphakic eyes, out-of-the-bag IOL fixation in the sulcus supported by sufficient residual capsule provides advantages of less surgical trauma, shortened surgical time, reduced risks of related complications, and quick visual rehabilitation1; however, out-of-the-bag IOL fixation in aphakia after pars plana vitrectomy is challengeable because vitrectomized eyes have a high incidence of insufficient capsular support in terms of disintegrated lens capsule and (or) zonular defect due to various reasons including traumatic factors before vitrectomy, vitrectomy-related capsular/zonular impairment, basal inferior iridectomy, postoperative capsular contraction, and combination of these etiologies.2–6 The typical sign of a significant zonular defect in the aphakia is the “D”-shaped continuous curvilinear capsulorhexis (CCC) opening results from loss of zonular traction similar to iridodialysis (Figure 1A). Sulcus implantation in eyes with insufficient capsular support may result in IOL decentration/dislocation and IOL migration into the vitreous cavity through the area of the defect. Although there are various devices to fixate capsular bag in the eyes of in-the-bag IOL subluxation or in cataract surgery of subluxated lenses for intracapsular IOL implantation, there is no study reporting the reconstruction of capsular support for outof-the-bag fixation.7–16 We have described a flapless technique of intrascleral fixation of implantable capsular hooks to refixate the capsular bag of a dislocated IOL–capsular bag complex and fixate capsular bag of subluxated lens for in-the-bag IOL implantation in the previous publications.17,18 The CCC rim is gripped by the hook for capsular stabilization. The needle attached to the hook is passed intrasclerally, leading the hook incarcerated in the sclera. The technique is less traumatic and avoids the need for the creations of large conjunctival dissections, scleral flaps, or complicated manipulations of suturing and knotting. We have further used the technique to reconstruct the capsular support for out-of-the-bag IOL fixation in the vitrectomized eyes with capsular/zonular defect (Figure 1B).