OSLI Retina

February 2020

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February 2020 ยท Vol. 51, No. 2 125 The Cutting Edge Surgical video section with expert commentary The authors present a case using a modified flanged intrascleral intraocular lens (IOL) fixation technique to rescue a dislocated IOL. A unique feature of their technique is the docking of the IOL haptics with the 30-gauge needle within the vitreous cavity rather than the anterior chamber. Inserting the haptics into the needles requires per- fect alignment, which is easier to accomplish within the wider vitreous cavity after a thorough vitrectomy. Therefore, it is pos- sible to insert the haptics into the needles sequentially with- out using the simultaneous double-needle technique described in our origi- nal method. Furthermore, potential damage to the corneal endothelium or the iris is minimized with this technique; however, the necessity for the chandelier is an added maneuver and expense that is worth considering. I usually prefer to dock the haptics in the anterior chamber but have found the authors' technique helpful in some situations. Intrascleral IOL fixation rescue is ideal if the dislocated IOL is a three-piece, but I would caution that dislocated IOLs that have been fixed in the bag for a long time are not ideal because the hap- tics may be deformed. Even if properly fixed into place during surgery, the IOL may subsequently decenter or tilt due to deformation of the haptics. Additionally, if a significant Soemmering's ring is present, this may sometimes be difficult to remove with a vitreous cutter. It was fortunate that, in this case, only a few days had passed since cataract surgery, making this patient the ideal candidate. The authors showcase nicely a surgical tech- nique that allows for repositioning of a dislocated three-piece IOL without lifting it into the anterior chamber. It is important to confirm there is no de- formation of the IOL haptics before proceeding with fixation. Shin Yamane, MD Department of Ophthalmology Yokohama City University Medical Center Yokohama, Japan Shin Yamane, MD Modified Flanged Intrascleral Fixation of Intraocular Lens for Vitreoretinal Surgeons Mehdi Najafi, MD, PhD; Richard H. Johnston, MD ABSTRACT: The surgeons have modified the flanged intrascleral intraocular lens (IOL) fixation technique initially described by Yamane et al. to avoid manipu- lation of the IOL within the anterior chamber. Their technique involves securing the IOL haptics into receiving needles within the posterior segment. Ad- vantages of this technique include repositioning and securing a dislocated three-piece IOL to the sclera without removing the lens or creating a large corneal incision. S urgical techniques for scleral fixation of an in- traocular lens (IOL) in eyes with inadequate capsular support have expanded remarkably during the past few years. A common approach is the sutureless flanged intrascleral IOL fixation tech- nique described by Yamane et al. 1 This involves ex- ternalizing IOL haptics through scleral tunnels cre- ated with 30-gauge needles and securing them to the sclera using small flanges created with cautery. The elegant use of haptic flanges avoids the need for creat- ing scleral tunnels 2 or using surgical glue 3 and greatly simplifies the surgery. We have adapted the Yamane technique to be fa- miliar for vitreoretinal surgeons. 4 Our technique in- volves feeding the IOL haptics into receiving needles with a procedure confined to the posterior segment. With this, we avoid manipulations of the lens within the anterior segment. Our approach allows for re- fixation of displaced three-piece IOLs to the scleral without creating a large corneal incision and perform- ing a lens exchange. In situations with a dislocated

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