GLUED INTRASCLERAL HAPTIC FIXATION IOL

MY TECHNIQUE

George H. H. Beiko, BM, BCh (Oxon), FRCSC

Stable intraocular lens (IOL) placement can be a challenge in cases of postsurgical aphakia, subluxated cataract, ectopia lentis, traumatic subluxation, and decentered IOLs. Scleral fixation without sutures, employing a specially designed IOL, was first described in 1997.¹ However, it was not until 2007 that Scharioth published a technique that could be used for scleral fixation of routinely implanted 3-piece IOLs.² Amar Agarwal has popularized a technique of fibrin glue–assisted intrascleral haptic fixation. He first described this method in 2007, published it in 2008,^3–6 and more recently has edited a book on this technique.⁷ I have personally used the glued IOL technique since 2009. During that time, I have used a small modification of this technique, which I would like to share.

The technique as described by Agarwal requires that an assistant hold the haptics of the IOL once they have been externalized through the sclerotomies. If an assistant is not available or not capable of holding the haptic, it has been my unfortunate experience that the externalized haptic will be pulled into the eye during the process of externalizing the second haptic or during other intraocular maneuvers. This necessitates repeating externalization of the haptic and prolongs the procedure. In order to prevent the first haptic from sliding back into the eye, it is possible to use a silicone tire.

Surgical Technique

Silicone tires or stoppers are the elements that slide along the shaft of capsule and iris retractors (Figure 42-1); they have repeatedly demonstrated the ability to provide grip and remain in place. Fortunately, the central opening is also the right size for fixating an IOL haptic. These tires are readily available from Mackool Capsular Support System hooks (Impex Surgical or Duckworth & Kent Ltd), MST Capsule Retractors (MicroSurgical Technology), or iris retractor sets (FCI Ophthalmics, Rayner Intraocular Lenses Ltd, Biotech Visioncare, and others).

The glued intrascleral haptic fixation technique, as pubished by Agarwal, is followed. Once the first haptic is externalized, a silicone tire is threaded onto it and advanced until it supports the haptic in the proper position. The second haptic is then externalized. A silicone tire is also placed onto the second haptic if further manipulation or intraocular surgery (such as a penetrating keratoplasty or trabeculectomy) is to be undertaken. After the scleral tunnels have been created, the tires are removed one at a time to allow each haptic to be threaded into the scleral tunnels.

Figure 42-2 illustrates the series of steps in threading the silicone tire onto an externalized haptic.

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