Sergio: In chapter one,
we showed you how the four-flanged technique
works with an unfoldable IOL,
based on Dr. Lewis and Dr. Yamane's techniques.
Let's see how the four-flanged technique worked
with a foldable IOL.
For starters, we present you
the first IOL punch ever developed,
advised to assist a surgeon.
With this IOL punch,
the surgeon will be able to punch two holes
in the optic zone in each side of the IOL.
After punching the two holes,
the procedure's pretty much the same as in chapter one,
where we used an unfoldable IOL.
Insert the 5.0 prolene suture inside the 26-gauge needle
and pull it out the eye.
Insert the first end of the suture
in the first hole of the IOL,
and make the first flange, using a portable cautery.
Repeat the procedure in the other side.
Pull off the 5.0 prolene suture out of the sclera,
insert the prolene in the second hole,
and make it a second flange.
Now, we have the two ends flanged.
But there's a question to be answered here:
what about iritis?
To avoid iritis and other problems that could come along,
we cut the haptics off the IOL with the help of scissors.
Now using a Utrata forceps,
it's possible to insert the IOL inside anterior chamber
through a 3.0 millimeter incision.
Adjust the IOL in the correct position using two forces.
Observe now how stable it is
and how you can center the IOL easily.
Once it's done, hold the base of the 5.0 prolene suture
that is coming out of the sclera.
Cut it,
and make the third flange using the portable cautery.
Insert the flange in these scleral tunnel.
Now repeat the maneuvering in other side.
Cut the suture on its base, make the fourth flange,
and inserted it in this sclera.
As we can see we have the IOL steady and center in the eye.
First tests, you see how the hydrophobic foldable acrylic
is stable in the traditional IOL.
Also, you can observe how the flange remains firm and steady
in the IOL while the haptic breaks down.
So in chapter one,
we showed you how the four flanged technique
works with an unfoldable IOL.
In this video here in chapter two,
we are showing you how to use that technique
with a foldable IOL.
On next chapter we'll discuss which one is better.
To make the IOL whole within horizontal or vertical axis.
And to finish up the series on chapter four,
we'll go through the IOL specifically designed
for this procedure.
Now do we really recommend
the use of the four flanged technique with a foldable IOL?
Not yet.
We're still researching to reach the best results.
On the next step,
we'll be checking which of these two are better:
horizontal or vertical axis to get the IOL still and steady.