Is This Really Sutureless Intrascleral Pocket Technique of Transscleral Fixation?

Dear Editor,

Cho et al. [1] described the "Sutureless intrascleral pocket technique of transscleral fixation of intraocular lens in previous vitrectomized eyes" in April issue. The authors prepare two scleral pockets with a crescent knife 2 mm from the limbus and opposed 180 degree each other without any conjunctival dissection. Following, they enter into the posterior chamber with a 26-gauge needle including 10/0 nylon suture transsclerally and transconjunctivally at a point of 1.5 mm posterior from the limbus. Following clear corneal incision (CCI), prolene sutures were exteriorized through the CCI pocket and a three-piece foldable acrylic intraocular lens was injected via CCI and the ends of the haptics were exteriorized through the CCI. The prolene sutures for each haptic in the intrascleral pocket bed were then tied and knots were buried under scleral flaps, in their technique.

To us, this description and title were not completely true. This technique is not a sutureless one. In fact, it is a modified sutured and intrascleral pocket technique of transscleral fixation of intraocular lens. In sutureless techniques defined until now, a permanent suture was not used inherently [2,3,4,5]. In the trocar-assisted technique of sutureless intrascleral posterior chamber foldable intra-ocular lens fixation which we described, we put a non-absorbable 10/0 nylon suture transconjuncivally after the placement of the haptics into the scleral groove and take it out 1 week after [2,3]. We aimed to stabilize the haptics at early postoperative period. The authors defined their technique as the first scleral fixation method without conjunctival dissection and emphasized that it has the advantage of lack conjunctival dissection and lesser risk of conjunctival bleeding [1]. We disagree with authors about that. In the trocar assisted sutureless technique we developed, we have been entering into the eye with 25-gauge vitrectomy trocars without any opening of conjunctiva performing two 3 mm long scleral tunnels parallel to the limbus apart from 180 degree each other and angulating 10 degree with scleral surface. We performed vitrectomy entering by through these two cannulas. One haptic of the intraocular lens which implanted through a CCI is held with a forceps that inserted through CCI and grasped in the eye with a forceps that inserting into and removed from the eye via trocar cannula and placed into the tunnels. We put a 10/0 nylon suture encircling the haptic for security and take it out 1 week after. By repeating same processes for other haptic, both haptics became implanted into the scleral tunnels. The advantages of our technique are lack of conjunctival dissection and scleral flaps in addition to minimal possible damage to circumferential tissues. We do not encountered with any complication such as decentralization or tilt of intraocular lens, endophthalmitis, glaucoma and retinal detachment [2,3]. In terms of simplicity, we think that our method is simpler and needs shorter surgical time as it does not need to prepare conjunctival dissection and scleral flaps.