-: In this video, we will describe a novel
and a revolutionary technique
for sutureless scleral fixation
of an intraocular lens, in which all maneuvers are performed
outside of the eye using an 18-gauge IV catheter.
The aim of this method is to facilitate scleral implantation
as much as possible while ensuring stable fixation
without any tilting or any major surgical risks
and with a very short learning curve.
We call this technique Shamil Technique 2.0.
So, all we need for our procedure is showed in this picture.
A regular IOL injector, 18-gauge IV catheter, 6-0 Prolene,
our IOL, some cautery, and the 30-gauge needle.
So we start by taking the 18-gauge catheter
and piercing it with a 27-gauge needle making 4 holes,
which we can number from 1 to 4.
We then take our 6-0 Prolene
and make some double overhand knots on all 4
of its haptics, as you can see in the video now.
We did the first two and then we will proceed
to do the double overhand knots on the last 2 haptics.
Once that's done, we can label the ends of the 6-0 Prolene
from 1 to 4 and then pass them
through the corresponding hole of the IV catheter.
As you can see in the video, we start from the first one,
the second, number three now,
and then we will finish with the number four
as we pass it through the IV catheter.
So this will allow us to avoid any tangling
of the ends of the Prolene while we pass it
through the injector, as you can see in the picture.
So we proceed by cutting the base of the IV catheter
and placing the IOL into the cartridge.
It is very important
to always maintain the same orientation.
We then pass the catheter through the tunnel
of the cartridge while maintaining the same horizontal
orientation with the holes always on the right side.
This is very important to avoid any tangling
of the 6-0 Prolene ends.
So you can see they are very organized right now,
and then we mount the cartridge onto the injector
and we fix the IV catheter on the left side
of the injector using a strip.
And with this, our mounting
or our injection system is ready to use.
So, we can now start our surgery.
The surgery is done under sub-Tenon anesthetic block,
and we want to ideally work under positive pressure using
either an anterior chamber maintainer or infusion terminal.
After an anterior vitrectomy,
a 2.75-millimeter incision is made at 12 o'clock
and then we start marking the sides of the sclerotomy,
which are 2 millimeters from the limbus
and 3 millimeters at the top
and bottom of the horizontal meridian.
The end of the first Prolene is taken out of its hole
to prepare it for the first handshake.
We then insert the 30-gauge needle through the conjunctiva
and the sclera while creating an intrascleral tunnel.
Once it enters the globe, it is received using the tip
of the viscoelastic cannula
and passed through the cornea incision
to facilitate the handshake maneuver,
as you can see. The end of the Prolene is then passed
through the 30-gauge needle
and then exteriorized through the sclera.
So the same maneuver is carried out for the other ends
of the Prolene number two, three, and four.
As we can see now, we are at number two,
always exteriorizing the tip of the needle
to facilitate the handshake
and then do our usual handshake
and exteriorize the 6-0 Prolene and outside of the sclera.
So, it is really important now that we have
finished the number one and number two ends of the Prolene
before passing the number three.
And then before, we must always make sure
that it is being passed above the first
and the second ends of the Prolene ends.
So, this is really important to avoid any tangling
of the Prolene ends and to have a smooth IOL injection.
The IOL is then injected into the posterior chamber
of the eye through our 2.75 incision.
And after the positioning and well-centering of the IOL,
we create a small hypotony of the globe
by stopping the infusion
and releasing a small amount of liquid through the incision.
We then proceed to cut the ends
of the Prolene 2 millimeters from their base,
and then with some cautery, we create flanges.
These flanges will be buried automatically
into the sclera once we reactivate the infusion,
as you can see now in the picture.
And with this, we have finished our case
of IOL sclera fixation.
We can add some myotics into the eye to create some myosis,
but as you can see, result is really good.
We have a very stable and well-centered IOL.