Treatment of anterior vitreous before suturing an intraocular lens to the ciliary sulcus

Abstract

Purpose: To clarify the relationship between suturing an intraocular lens (IOL) and residual vitreous after vitrectomy and transscleral IOL suturing. Setting: Toranomon Hospital, Tokyo, Japan. Methods: Enucleated pigs’ eyes were fixed to the observation device. Three methods for removing the crystalline lens and the vitreous were tested; an IOL was then sutured to the ciliary sulcus. Miyake’s posterior approach and an endoscope were used to observe the movement of fluorescein-stained residual vitreous during these procedures. Results: Considerable residual vitreous and extensive vitreous entwinement with the IOL were seen when IOL suturing followed anterior vitrectomy through a limbal incision. These were absent when IOL suturing followed careful pars plana vitrectomy and capsulectomy. Conclusions: Our findings indicate that suturing the IOL to the ciliary sulcus should be followed by the removal of as much anterior vitreous and lens capsule as possible to prevent such postoperative complications as tractional retinal detachment and cystoid macular edema.