Abstract
BACKGROUND/OBJECTIVES: The trans-scleral four-point fixation technique was introduced to provide a stable lens fixation in patients with inadequate capsular support. This technique most commonly uses Akreos-AO or Micropure lenses with a Gore-Tex suture. This study aimed to report long term outcomes and complications of this technique. SUBJECTS/METHODS: Patients who underwent insertion of a Gore-Tex sutured, scleral fixated intraocular lens between April 2019 and May 2023 in Moorfields Eye Hospital, London were identified. Operative details and postoperative outcomes were collected retrospectively from electronic case record review. Data collected included demographic details, indications for surgery, intra-operative or postoperative complications, refraction and best corrected visual acuity (BCVA). RESULTS: 106 patients were included (median age 63 (17-83)). Indications were IOL complications (69/106, 65%); aphakia (18/106, 17%); or subluxed crystalline lens (19/106, 18%). Median follow-up was 77 weeks (range 10-200). Median postoperative BCVA was 0.3 LogMAR (IQR 0.2-0.6) at final visit with a median improvement of 0.4 LogMAR. The median postoperative spherical equivalent was -0.25 dioptres(D), with -1.75D astigmatism. Postoperative complications included cystoid macular oedema (8.5%), endophthalmitis (1.8%) and suture issues, including re-threading (1.8%), conjunctival resuturing (1%) or knot repositioning (4%). 10 patients had pre-existing corneal pathology and subsequently had a planned corneal graft. CONCLUSION: Gore-Tex fixated IOLs provide good visual improvement with long-term IOL stability. This series reports all patients who underwent the surgery including those performed during the learning curve and training, showing real-world outcomes.