Modified Four-Point Scleral Suture Fixation Technique for Repositioning a Dislocated Intraocular Lens in the Absence of Capsule Support

Figure 1

Surgical steps. (a) A dislocated intraocular lens (IOL). (b) After the IOL was brought to the posterior chamber, a CIF-4 needle with a double 10-0 polypropylene (Prolene®) suture was passed through the partial thickness of the sclera at the incision from the 9 o’clock to the 7 o’clock position. (c) The needle was inserted into the posterior chamber through the sclera at the 7 o’clock position and was passed through the nasal inferior eyelet and then externalized through the limbus at the 1 o’clock position. (d) The needle was then removed, and the suture was reintroduced into the anterior chamber and passed through the nasal superior eyelet using vitreous forceps. (e) Using these vitreous forceps, the suture was then externalized through the scleral incision at 9 o’clock. (f) On the temporal side, after passing through the sclera from 3 o’clock to 1 o’clock, the needle was introduced into the posterior chamber, passed through the temporal superior eyelet, and externalized through the nasal limbus incision with the help of vitreous forceps. (g) Through the same incision, the needle was reintroduced into the anterior chamber, passed through the temporal inferior eyelet, and externalized through the scleral incision at 3 o’clock using vitreous forceps. (h) The two ends of the suture, on both sides, were tied and care was taken to centralize the IOL. Then, the suture with a CIF-4 needle was tied to the other suture tail (or tails lacking a needle) using a sliding knot (shown in the small diagram). (i) The sutures were passed through the partial thickness of the sclera, twice, using a technique similar to the Z-suture technique described by Szurman et al.

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