Intraocular Suturing of the Dislocated IOL to the Ciliary Sulcus

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Intraocular Suturing of the Dislocated IOL to
the Ciliary Sulcus
Katsunori.Ishii.MD Rui.Hiramatsu.MD
Yuki.Kamiya.MD Ryohei.Koide.MD
Pre
Post
SHOWA UNIVERSITY School of Medicine
Tokyo Japan
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PURPOSE

• To describe a technique of intraocular
  double-knot suturing for scleral fixation of in
  the bag dislocated intraocular lens
• METHOD
• We are using two 20-gauge corneal tunnels with
  20-gauge CCC forceps
• We should move the haptic of dislocated
  intraocular lens on the iris

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STEP 1 (Below the haptic)
Scleral flap, two 20 gauge corneal tunnels are
created. Viscoelastic needle is inserted below
the dislocated haptic, and docked with double
long 10-0 straight needle through the lens
capsule.
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STEP 2 (Above the haptic)
A 20G CCC forceps is inserted above the haptic,
used to grasp the 10-0 suture on the optics
softly and then 10-0 suture in a U shape is then
guided corneal tunnel.
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STEP 3 (First ligature)
We selected a 10-0 suture in a U shape through
both corneal tunnels. The selected 10-0 suture is
rotated twice clockwise on a straight needle.
Both straight needles are slowly pulled back, and
the first ligature is made on the haptics in the
eye.  
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STEP 4 (Above the haptic again)
Following the first ligature, a 20G CCC forceps
is inserted above the haptic again, used to grasp
the 10-0 suture on the optics softly and then
10-0 suture in a U shape is then guided corneal
tunnel.
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STEP 5 (Second ligature)
Following the first ligature, we selected a 10-0
suture through both corneal tunnels. The
selected 10-0 suture is rotated once
counter-clockwise a straight needle. Both
straight needles are slowly pulled back, and the
second ligature is made on the haptics in the eye.
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STEP 6 (Cutting a 10-0)
Following the Second ligature, we cut a 10-0
suture of double knot out of the cornea.
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STEP 7 (Intraocular suturing)
A long needle is once again inserted into the eye
though corneal tunnel a 25G needle is threaded
through the corneoscleral flap and docked inside
the eye, the loop is in position below the iris,
and intraocular suturing is complete.
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CASE
age Post- VA Pre-ope complications Percent decrease in endothelial cells operation (min)
76 10/100 Dementia 6(2907?2740) 32
58 1/100 Post-RD Not measured 59
63 20/20 Not measured 30
37 20/20 1(2725?2710) 55
48 20/20 Post-RD 4(2660?2558) 46
63 20/20 3(2652?2584) 37
28 20/20 Post-RD Not measured 55
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DISCUSSION

• In the bag IOL dislocation is uncommon
  complication
• This intraocular suturing is simple and strong
  ligature, in addition, the site was small.
• This procedure reduced operating time and
  required no vitrectomy, because of the limited
  impact on the capsule.
• We experienced the postoperative temporary high
  intraocular pressure, because of residual
  viscoelastic substance.
• There were few previous cases in which this
  procedure was used , and careful follow-up is
  required in the future.

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REFERENCE

• 1)Dimitri T.Azar,William F.WileyDouble-knot
  transscleral suture fixiation technique for
  displaced interaocular lensesAm J
  Ophthalmol128644-646.1999
• 2)Koh HJ,Kim CY,Lim SJ et al Scleral fixation
  technique using 2 corneal tunnels for a
  dislocated intraocular lens. J Cataract Refract
  Surg 26 1439-1441,2000
• 3)Kwok AKH, Cheng ACK, Lam DSC Surgical
  technique for transcleral fixation of a
  dislocated posterior chamber intraocular lens .Am
  J Ophthalmol 132 406-408.2001
• 4)Kokame GT, Atebara NH, Bennett MD Modified
  technique of haptic externalization for scleral
  fixation of dislocated posterior chamber lens
  implants. Am J Ophthalmol 131129-130.2001
• 5)Hanemoto T, Ideta H,Kawasaki T Dislocated
  intraocular lens fixation using intraocular
  cowhitch knot.Am J Ophthalmol 131 265-267,2001