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  • Written By: John A. Hovanesian, MD, FACS
    Cataract/Anterior Segment

    The author, Priya Narang, MS, describes a modified technique for externalizing the haptics during cataract surgery while using the Agarwal method of glued intrascleral fixation of a posterior chamber IOL. This technique eliminates the role of an assistant in holding the haptic during the entire surgical maneuver and any complications associated with inappropriate handling of the haptic. It's good that the technique Amar Agarwal, MBBS; MS; FRCS; FRCOphth (Lon), has been advocating for nearly five years is finally gaining ground and seeing modifications by others.

    Dr. Agarwal's technique is aimed at restoring pseudophakia in complicated cases in which the posterior capsule is deficient or is inadequate to support an IOL. Externalizing the haptics is one of the most crucial steps. This technique is an attempt to make the process of haptic externalization, considered the most technically demanding part of the surgery, easier and more feasible. The author report that the technique was successful in 45 cases, with no intraoperative complications.

    The modified haptic externalization technique described by the author works on the principle of vector forces. The direction of vector forces changes completely once the trailing haptic reaches or crosses the mid-pupillary plane. This causes further extrusion of the leading haptic from the sclerotomy site and eliminates the need for an assistant. The play of vector forces causes the leading haptic to remain extruded from the sclerotomy site, with no chance of slippage or any other intraoperative complication associated with improper assistance. The manipulation of the trailing haptic is done along the mid-pupillary plane or slightly beyond it, toward the 6 o'clock position to ensure the correct play of forces.

    The author concludes that this modified haptic externalization technique is precise, predictable, and easy, and can be used to maintain externalization of the leading haptic during the entire surgery. By decreasing dependence on the assistant, it makes the procedure more surgeon dependent.