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Inject first and then fixate hydrophobic single piece ALCON AcrySof IOL

Zia ul Mazhry, MD

This video focuses on a simplified technique for scleral fixation of hydrophobic single piece Acrylic AcrySof posterior chamber IOL. Zia ul Mazhry, MD, presents an aphakic, vitrectomized eye of 75 years old female with complete absence of capsular support. A double haptic scleral fixation (DHSF) of IOL was planned under local anesthesia. Two 2.75 mm corneal incisions were fashioned at 12 and 6 o'clock positions. Scleral tunnels were prepared in ST and IN quadrants 180 degrees away from each other. Dual arm 9/0 polypropylene (Prolene) trans-scleral suture was passed using Ab Externo technique with 27 G bent needles 1 mm behind limbus through both fixation sites. Both the sutures were presented through respective 2.75 mm incisions. An Acrysof single piece IOL was injected as per routine using monarch-2 injection system. The IOL was placed in anterior chamber. Haptics of the IOL were externalized through respective 2.75 mm incisions. Prolene suture was tied at the point of maximum convexity and haptic internalized. Similar procedure was repeated with second haptic. The IOL was dialed behind the iris and the tied haptics positioned in ciliary sulcus by applying gentle traction on the respective fixation sutures. After assuring the centration, the fixation sutures were tied to itself and buried inside the scleral tunnel. Scleral and conjunctival approximation was performed. Anterior chamber was formed after hydrating the corneal incisions. The procedure was found to be much less traumatic as compared to other described scleral fixation techniques. The IOL was injected as per routine and the anterior chamber remained formed throughout the procedure minimizing the risk of hypotony. As a final pearl, the author recommends that surgeons inject first and then fixate to achieve an effective and safe option for scleral fixation of hydrophobic single piece acrylic Acrysof posterior chamber IOL in eye with partial or complete absence of posterior capsule.

Posted: 4/14/2014