PREPARATION. (2) Marking 2 mm posterior to the limbus in the area of the haptic on the side of maximal zonulopathy.

INITIAL SUTURE. (3) In this case of an in-the-bag dislocation of a multifocal IOL, Prolene suture is threaded into the lumen of a trans- scleral needle placed through the capsular bag between the haptic and the optic.

NEEDLE PLACEMENT. (4) The needle is placed through the conjunctiva and sclera, between the optic and haptic and through the capsular bag, and then loaded with Prolene suture using microforceps intraocularly.

VARIATION USING PRELOADING. (5) A variation on the technique: preloading the needle with Prolene suture prior to passing through conjunctiva and sclera.

VARIATION USING EXTERNALIZATION. (6) Another variation on the technique: externalizing the needle through a paracentesis and loading the Prolene suture into the needle lumen outside the eye. This is probably the most straightforward way to load suture into the needle.

VARIATION IN PATIENT WITH GLAUCOMA. (7) This patient had a functioning elevated avascular bleb after trabeculectomy. This image shows placement of the second needle through the conjunctiva and sclera and then into the sulcus in front of the haptic and capsular bag.

CREATING THE BELT LOOP. (8) The trailing end of the Prolene suture is threaded into a second needle placed through the conjunctiva and sclera and into the sulcus in front of the lens/bag complex. This creates a belt loop around the haptic.

CAUTERY. (9) Low-temperature handheld cautery is used to create a small flange.

BURYING THE FLANGE. (10) The flange is buried into the superficial layers of the sclera using a fine forceps to avoid future erosion through the conjunctiva and exposure of the flange.