Determination of haptic position of transsclerally fixated posterior chamber intraocular lenses by ultrasound biomicroscopy

Transscleral fixation of posterior chamber intraocular lenses has become an increasingly popular procedure in eyes lacking adequate posterior capsular support. The assumption is generally made that these lenses are fixated in the ciliary sulcus. To test this assumption, 17 cases with transsclerally fixated posterior chamber intraocular lenses were examined with ultrasound biomicroscopy, a new method of producing subsurface images in living eyes at microscopic resolution. All lens haptics were easily visualized with this technique. Of 34 haptics in 17 patients, 13 were adequately located in the sulcus region, eight were located posterior to the ciliary processes, and 13 were located anterior to the sulcus region, accompanied by some degree of angle closure. Haptics with a more posterior scleral exit of the suture tended to be located more posteriorly. The cases in which the haptics were located anteriorly had scleral exit points from 1 mm to 2 mm from the limbus. The surgical placement of transsclerally fixated lenses is a blind procedure in most cases. Our series demonstrates the difficulty in reliably placing the haptics in the ciliary sulcus.