Abstract: Objective To observe the efficacy of the scleral fixated intraocular lens implantation with knotless Z-suture technique for moderate severe inadequate capsule/zonular support. Design Retrospective case series. Participants Eighty-eight eyes of 78 Moderate to severe inadequate capsule/zonular support patients, who were cases with over 180°zonular weakness or residual capsule inadequate to support intraocular lens ciliary groove implantation, were included from July 2017 to January 2021 in Ocular Trauma Department of Beijing Tongren Hospital. Methods All patients underwent surgeries including the standard procedure of scleral fixated intraocular lens implantation with knotless Z-suture technique. The median follow-up duration was 19 months (range 12~50, quartile 15~25.5 months). Preoperative and postoperative visual acuity, complications, intraocular lens position were observed. Main Outcome Measures Uncorrected visual acuity, best corrected visual acuity (BCVA), complications, and intraocular lens position. Results The uncorrected visual acuity was hand motions～0.4 at baseline. It improved to 0.04～1.0 at 6th month follow-up including 80 eyes (90.9%)≥0.3. The BCVA improved significantly from 0.79±0.36 at baseline to 0.20±0.15 at last follow-up (t=-9.783, P<0.001). No suture-related complications such as wound leakage at the sutures, sclera thinning, sclera melting, chronic inflammation around the suture, suture erosion, suture exposure, and endophthalmitis was observed in any cases. The Z-sutures were invisible in all cases under the slit lamp microscopy. Complications requiring invasive treatment were retinal detachment in 1 eye (1.1%) and intraocular lens pupillary capture in 1 eye (1.1%). Both cases were children with Marfan syndrome. All the other intraocular lens were in the expected position without obvious pseudophakodonesis, dislocation, decentration or tilt. No cystoid macular edema, corneal endothelial decompensation, secondary glaucoma, suprachoroidal hemorrhage or endophthalmitis was observed. Conclusion Knotless Z-suture technique can effectively reduce the occurrence of suture-related complications which is applicable for various cases of moderate to severe inadequate capsule/zonular support. (Ophthalmol CHN, 2022, 31: 207-212)

Key words: inadequate capsule/zonular support, scleral fixated intraocular lens implantation