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Priya Narang
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Dr. Priya Narang, MS, presents a glued IOL technique in a lens coloboma with Marfan's Syndrome case. The management of lens coloboma often necessitates the use of capsular tension rings (CTR) and endocapsular segments (ECS). Other problem associated with such cases is the intraoperative challenge of fixing the CTR and ECS along with prevention of the vitreous herniation in to the anterior chamber. The postoperative challenges of IOL decentration and capsular phimosis and degradation of suture also defy the success of performing a surgery. To overcome all these sticky situations, a glued IOL surgery was performed but that too has its own set of limitations especially in big eyes as in a case of Marfan's Syndrome. Following the externalization of haptics, it was noted that the length of the haptic externalized on right side was inadequate so as to be properly tucked in to the scleral pockets. A fresh sclerotomy was then created in front of the previous one, taking care that the direction of the needle should be more vertical so that the tip of the needle passes behind the iris as this path would serve as a site of future haptic externalization and the surgeon at no point of time wants the haptic to be anterior to the surface of the iris. Once sclerotomy is created, the previously externalized haptic is introduced back in to the eye and ‘Handshake technique' is done to re-externalize the same haptic from the anteriorly created sclerotomy incision. This method has an advantage of making extra length available for tucking and thereby enhancing the stability and strength of the IOL tuck.
Posted: 6/09/2014
Priya Narang
Dr. Priya Narang, MS, presents a glued IOL technique in a lens coloboma with Marfan's Syndrome case. The management of lens coloboma often necessitates the use of capsular tension rings (CTR) and endocapsular segments (ECS). Other problem associated with such cases is the intraoperative challenge of fixing the CTR and ECS along with prevention of the vitreous herniation in to the anterior chamber. The postoperative challenges of IOL decentration and capsular phimosis and degradation of suture also defy the success of performing a surgery. To overcome all these sticky situations, a glued IOL surgery was performed but that too has its own set of limitations especially in big eyes as in a case of Marfan's Syndrome. Following the externalization of haptics, it was noted that the length of the haptic externalized on right side was inadequate so as to be properly tucked in to the scleral pockets. A fresh sclerotomy was then created in front of the previous one, taking care that the direction of the needle should be more vertical so that the tip of the needle passes behind the iris as this path would serve as a site of future haptic externalization and the surgeon at no point of time wants the haptic to be anterior to the surface of the iris. Once sclerotomy is created, the previously externalized haptic is introduced back in to the eye and ‘Handshake technique' is done to re-externalize the same haptic from the anteriorly created sclerotomy incision. This method has an advantage of making extra length available for tucking and thereby enhancing the stability and strength of the IOL tuck.
Posted: 6/09/2014
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