Scleral Fixation of IOL in Jalandhar

In a normal cataract surgery, the artificial lens (called an IOL, or intra-ocular lens) is placed inside a thin, clear bag called the capsule, which held the natural lens. Sometimes this bag is missing, torn or too weak to hold a lens. The eye is then left without a lens, or with a lens that has slipped out of place, and vision is very poor. Scleral fixation of IOL is a surgery that solves this. The lens is fixed to the sclera — the strong white wall of the eye — so it stays in position for life.

This is a specialised surgery that needs skill in both the front and the back of the eye. At Drishti Eye Care & Retina Centre in Lambra, Jalandhar, Dr Nalini Saxena performs it as a fellowship-trained vitreo-retinal surgeon who has also completed over 5000 cataract surgeries.

What is scleral fixation of IOL, and who needs it?

Think of the capsule as a hammock that holds the lens in the middle of the eye. The hammock hangs from fine threads called zonules. If the hammock or its threads are damaged, a normal lens implant has nothing to sit on. In scleral fixation, the lens is instead tied or tucked into the wall of the eye, well behind the coloured part, so it sits in the same central position as a natural lens.

You may need this surgery if:

• Your natural lens has dislocated — slipped out of place — after an injury, in very high short-sightedness, or in some conditions people are born with
• A lens implant from an earlier cataract surgery has dropped backwards into the eye, or is tilted and moving
• A cataract surgery years ago was done without putting in a lens, so you depend on very thick glasses or a contact lens
• A complicated cataract surgery, or a very hard or injured cataract, left the capsule unable to support a lens (see complex cataract surgery)

Symptoms of a dislocated or missing lens

• Sudden or gradual blurring of vision in one eye that glasses do not fully correct
• Vision that changes when you move your head, or a “wobbling” image
• Seeing the edge of the lens implant, or double images from one eye
• Glare and halos, especially at night
• Needing a very thick plus-number glass in one eye after cataract surgery
• Eye pain, redness or raised pressure from a lens rubbing inside the eye

When to see a doctor

If vision in one eye drops suddenly, especially after a knock to the eye or after a cataract surgery, get examined soon. A dislocated lens or implant that is left inside the eye can cause raised pressure, swelling of the retina, and damage to the cornea. The earlier it is handled, the simpler the surgery.

How Dr Nalini performs scleral fixation

This surgery sits exactly at the meeting point of cataract surgery and retinal surgery — and that is Dr Nalini Saxena's training. She did her MS in Ophthalmology at Maulana Azad Medical College, then a dedicated vitreo-retinal fellowship at Venu Eye Institute and Research Centre, New Delhi, and two months of advanced training in complex vitreo-retinal and cataract surgery in Germany. She has also passed the examination of the Royal College of Surgeons.

The surgery usually has two parts:

1. Clearing the eye. If a lens or implant has dropped to the back of the eye, it sits in the vitreous jelly, close to the retina. Dr Nalini removes the jelly through tiny stitchless openings, lifts the dropped lens forward, and takes it out safely. This part needs a retina surgeon.
2. Fixing the new lens. A lens designed for fixation is placed inside the eye and its supporting arms are anchored to the sclera on either side, so it sits centred and stable. This is done through very small openings, and stitches are kept to a minimum.

Because both parts are done by the same surgeon in one sitting, you avoid two operations and two hospitals.

What to expect on the day

• Before surgery: a full examination of the front and back of the eye, measurement of eye length and curvature to choose the lens power, and blood tests and a fitness check. Diabetes and blood pressure should be under control.
• Anaesthesia: most adults have local anaesthesia — an injection around the eye — and stay awake and comfortable. Children and some special cases need general anaesthesia.
• The surgery: longer than a routine cataract surgery, usually around an hour, depending on whether a dropped lens has to be removed first.
• Going home: the eye is padded and you go home the same day or the next morning, with someone accompanying you.

Recovery after scleral fixation of IOL

Healing is a little slower than after a simple cataract surgery, because more work has been done inside the eye:

• Vision is blurry for the first days and improves over two to six weeks.
• Use the eye drops exactly as prescribed for several weeks. They prevent infection and control inflammation.
• Do not rub or press the eye. Wear the protective shield at night for the period advised.
• Avoid heavy lifting, bending forward, and dusty or smoky places for a few weeks.
• Mild aching and redness are expected in the first week. Sharp pain or a sudden drop in vision is not — call us right away.
• Glasses for fine-tuning distance vision and for reading are prescribed once the eye has settled, usually after a few weeks.

Follow-up continues for some months to confirm the lens is stable, the eye pressure is normal and the retina is healthy.

Cost of scleral fixation of IOL in Jalandhar

The cost varies more than for a standard cataract surgery, because no two of these eyes are the same. It depends on:

• Whether a dropped lens has to be removed first. Removing a dislocated lens or implant from the back of the eye adds a vitreo-retinal step.
• The type of lens used for fixation.
• Anaesthesia — local for most adults, general for children.
• Other problems in the eye that need treatment at the same time, such as raised pressure or retinal swelling.

After the examination you receive a written estimate covering the surgery, lens and follow-up. Ask our staff about insurance and government scheme paperwork.

Frequently asked questions