Closed-globe technique for fixating a subluxated posterior chamber IOL

In this brief correspondence, Stefano Zenoni, MD, and his colleagues present a very useful and timely technique for dealing with the vexing problem of a subluxated posterior chamber IOL without opening the sclera. This technique involves a partial-thickness limbal-based scleral flap 2.0 mm from the limbus on the meridian where the loop of the dislocated IOL is to be sutured. The authors say it is well-suited for vitrectomized eyes, since it prevents the bulb from collapsing.

They describe and illustrate the steps necessary to perform the technique. It involves introducing a long straight needle mounted on polypropylene 10-0 through the scleral flap, with the tip directed toward the limbus at a point diametrically opposite the entrance and passing under the IOL haptic. The needle must exit the limbus for half its length, whereas the suture has to be retained below the IOL haptic. A 27-gauge insulin needle is introduced lateral to the polypropylene through the scleral flap. The polypropylene needle is then introduced in the lumen of the 27-gauge needle. During retraction of the 27-gauge needle, the polypropylene, locked within the lumen, is also extracted from the globe, forming a knot surrounding the loop of the IOL. By gently pulling the two ends of the suture, the IOL can be lifted and sutured to the sclera. The scleral flap and conjunctiva are sutured with polyglactin 8-0 (Vicryl).

The authors say that the main potential complication is breakage of the polypropylene suture as the suture is driven from the 27-gauge needle. If that occurs, the procedure must be started again from the beginning.

This is not just another way to skin the cat but particularly useful in the post-vitrectomized eye because of the clever way it avoids loss of chamber during the technique.

An abstract is not available for this correspondence.