Intrascleral Suture Anchoring: A Flapless/Grooveless Four-Point Intraocular Lens Fixation Technique

Figure 1

Intraoperative view of the surgical procedures. (a) Introduce the 8–0 polypropylene thread into the eye by the suture-in-needle technique using direct ab externo puncturing of a 30-gauge needle. Arrow 1: the first fixation point; arrow 2: the loop of the suture can be grasped by using forceps to retrieve it from the main incision. (b) After looping through the eyelets of the IOL, the thread is externalized by the curved-needle-retrieving technique. Arrow 1: the second fixation point; arrow 2: the tip of the curved 30-gauge needle. (c) After externalizing the four fixation sutures and implanting the IOL into the posterior chamber, the curved needle attached to the suture is held by a needle holder and intrascleral pass from the sclerotomy of the first fixation point (arrow 1) to the adjacent sclera (arrow 2) is performed. Arrow 3: the second fixation point. (d) Perform a relay intrascleral pass from the exit point (arrow 2) to exit the needle from the second sclerotomy (arrow 3). (e) Create the overhand fixation knot (arrow 1) by the two ends of the sutures to fixate the IOL. Create a second knot (arrow 2) 3 mm from the exit point and perform the intrascleral incarceration of the knot. (f) Perform the intrascleral pass of the curved needle attached to thread and knots from the second fixation point (arrow 1) to the adjacent sclera (arrow 2). (g) After pulling the thread to lead the threads and knots into the scleral tunnel, only four threads remain from the sclera. (h) After cutting all the externalized threads flush to the sclera, the IOL is well centered. Conjunctival incisions are left sutureless.

(a)

(b)

(c)

(d)

(e)

(f)

(g)

(h)