Abstract

SA.22.03

Z-suture – a new sutureless technique for the transcleral fixation of intraocular implants

Peter Szurman, Katrin Petermeier, Sabine Aisenbrey, Martin S. Spitzer, Gesine B. Jaissle
Department für Augenheilkunde, Universitäts-Augenklinik, Universitätsklinikum Tübingen, Tübingen

Objective
To introduce a new knotless suturing technique for transsclerally fixated intraocular implants.
Methods
Singe-armed 10-0 polypropylene sutures (Prolene®) were used for transscleral fixation of intraocular implants. The needle was passed through the sclera within a distance of 1.3 mm from the limbus and the attached intraocular implant was positioned in the sulcus. For reliable fixation without suture knots, a z-shaped intrascleral pass with five indentations was performed. The suture was then simply cut without any knot. To evaluate the number and amplitudes of indentations necessary for stable fixation of the suture within the sclera, an experimental series was performed using porcine eyes. Tractive forces necessary to mobilize the suture were measured for each parameter with an analogue Newton dynamometer.
Results
This Z-suture technique has been used in 67 patients including 45 cases of sutured IOLs, 18 cases of iris prostheses and 4 cases of iris diaphragms. No complications were observed except a transient mild ciliary hemorrhage in three eyes. In all patients, the implant stayed firmly fixed within the sulcus even after a mean follow-up time of 22.4 months (range 6.1 - 38.1 months). The resistance to tractive force increased with each pass of the z-shaped suture, but did not depend on the amplitude or the angle of the indentation. Using 5 indentations the suture resisted a maximal tractive force of 3.9 Newton that did not mobilize the suture, but exceeded the tensile strength of the suture.
Conclusions
The presented technique offers a stable and quick fixation of transsclerally sutured implants with sufficient resistance to tractive forces. By avoiding suture knots and hence the necessity for intrascleral flaps this may consecutively reduce complications like scleral necrosis, suture erosion and infections.

Copyright: 2009 Porstmann Kongresse GmbH. All rights reserved. Impressum, Disclaimer.