Posterior Chamber IOL Placement or Rescue Via a Sutureless Scleral Fixation Technique

Jonathan L. Prenner, MD, presents a novel approach that can be used for the rescue of a subluxed or dislocated IOL as well as for the implantation of a secondary IOL. The technique allows for permanent scleral fixation of the polypropylene haptics of a three-piece IOL directly into the sclera to achieve a position in the ciliary sulcus, thus obviating the need for suturing.

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Comments (9)

at our residency program, we did two of these cases this week, and it went well. we only had one microforceps, which makes the case difficult- i definitely agree with 2 forceps "handshake" technique. important to grab haptic at tip- the tail will break off once you manipulate it into the scleral tunnel. also, the resident pulled off the haptic entirely- one has to be mindful not to pull too hard when manipulating the iol. bottom line- its an excellent technique with a reasonable short learning curve. bravo again to dr. agarwal

ranchump (41 months ago)

Fortunately we have not seen that yet...but I am concerned about the long term stability in cases as you suggest...I recently had a competitive marksman who I chose not to perform this procedure on because of your concern about trauma dislocating the IOL.

Prenner (41 months ago)

Any problem with the haptic rotating out of its intrascleral tunnel with eye rubbing or eye motion?

Paul (41 months ago)

The haptic is placed within the 23g intrascleral tunnel and cut flush to the end of the tunnel if extra length exists. No subconjunctival haptic exposure exists with this technique.

Prenner (41 months ago)

The technique of intrascleral fixation of the IOL haptic utilizing the scleral flaps as described by Dr. Amar Agrawal, buries the haptic within the substance of the sclera. Having a subconjunctival haptic is providing an easy tract for organisms to enter the eye and thus causing endophthalmitis. Plus the patient is going to be able to see the haptic and be worried about what green / blue thing is seen in the otherwise white eye, thus cosmetically may not be acceptable to the patient.

DR. SHALABH (41 months ago)

We use the blade from the 23g trochar system to create the intrascleral tunnel. It is made 2mm from the limbus in a parallel fashion

Prenner (41 months ago)

excellenth you use a 23 G blade? how many mm from the limbus?

valerio1976 (41 months ago)

2.5-3 mm

Prenner (42 months ago)

how many mm needs to be done the scleral tunnel for IOL fixation?

tentuko (42 months ago)