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Akimoto, Masayuki MD, PhD; Taguchi, Hogara MD; Takahashi, Toshihide MD

Journal of Cataract and Refractive Surgery: May 2014 - Volume 40 - Issue 5 - p 854-855
doi: 10.1016/j.jcrs.2014.03.007
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In our article, we demonstrated a new technique for intrascleral fixation of an IOL using catheter needles in pig eyes. Using our method, we can support the IOL haptic without an assistant’s help and minimize intraocular manipulation.

Dr. Karadag and coauthors pointed out that the simulation procedure should be easy without complete removal of the lens, including the capsule, and without vitrectomy. In a few cases, we removed the capsule and performed a vitrectomy. In our experience, there were not many differences between vitrectomized and nonvitrectomized eyes, which may be one of the advantages of our method. An IOL dropped into the vitreous is a serious complication in intrascleral fixation of an IOL.1 Since the catheter needle holds the IOL haptic through the procedure in our method, the IOL can be delivered safely with or without the capsule.

As we indicated, fluid leakage from the surgical wound is a potential disadvantage of our method. However, since the total surgical time was relatively short, the amount of leakage was less than we expected.

Dr. Karadag and coauthors noted the problems in our method because of manipulation in both anterior and posterior chambers and possible damage of tissue behind the iris during the trailing haptic delivery. We agree with their suggestion that the surgical corneal wound should be around 11.5 mm in diameter for better simulation. In regard to the IOL suturing ab interno approach, the needle must be delivered from the anterior to the posterior chamber. The long curved needles with looped suture are often used for this purpose.2 To avoid blind penetration from the ciliary sulcus, a guiding needle is often used in combination.3 It may be difficult if a straight needle is used. We curved the catheter needle to perform the procedure easier. We also used a guiding needle to penetrate the sclera to deliver the trailing haptic from the vitreous cavity through the sclerotomy. When 2 needles are combined, the procedure is done through the pupil, not behind the iris, to minimize the needle-related complications. One may have to grasp and manipulate with a forceps in the eye; however, we had to hold only the catheter because it fixates the haptic tightly.

Using pig eyes, we could observe the behavior of the needles and haptics, which cannot be observed behind the iris in human eyes. The pig eye experiments were worthwhile in this regard.

It is important to keep in mind that there is potential tissue damage; however, we are comfortable with this procedure. Although use of a catheter needle, available in standard operating rooms, is an advantage of our method to avoid manipulation of the catheter needles and minimize the potential tissue damages, we have asked several companies about making modified blunt-end catheter-like needles.

We have improved our method with each clinical experience and believe the current technique is very manageable. We are preparing a clinical evaluation of our method in which most of the questions should be answered.

References

1. Agarwal A, Jacob S, Kumar DA, Agarwal A, Narasimhan S, Agarwal A. Handshake technique for glued intrascleral haptic fixation of a posterior chamber intraocular lens. J Cataract Refract Surg. 2013;39:317-322.
2. Stark WJ, Goodman G, Goodman D, Gottsch J. Posterior chamber intraocular lens implantation in the absence of posterior capsular support. Ophthalmic Surg. 1988;19:240-243.
3. Yaguchi S, Yaguchi S, Noda Y, Taguchi Y, Negishi K, Tsubota K. Foldable acrylic intraocular lens with distended haptics for transscleral fixation. J Cataract Refract Surg. 2009;35:2047-2050.
© 2014 by Lippincott Williams & Wilkins, Inc.