The SWISS IOL Technique (Small-Width Incision Scleral Suture): A Mini-Invasive Technique

Figure 1

Most important steps of the surgical technique. Intraoperative photographs showing the most important surgical steps (patient 2) (a). Marked sulcus position confirmed with endo-trans-illumination, usually at about 2 mm from the limbus (b). Insertion of the needle passing through the upper sulcus to the contralateral cornea by holding the needle at it basis (c); grasping the 10-0 polypropylene thread with the McPherson forceps, starting with the opposite threads (d), both 10-0 polypropylene threads are passed through the main incision and fixed with stripes superiorly. (e) Needle passing through the lower sulcus to the contralateral cornea by holding the needle with the right hand in the middle and then grasping the needle with the second hand at its basis (f); the right hand is grasping the upper left 10-0 polypropylene thread passed under the haptic, whereas the left hand is pushing the upper right thread of 10-0 polypropylene away (g). Both 10-0 polypropylene threads are well tied on the upper haptic (h). Right hand is maintaining the upper haptic to position the lower haptic in the paracentesis, while the left hand grabs the lower haptic with a small McPherson forceps as close as possible to its extremity (i). Externalization of the lower haptic with McPherson forceps (j). First knot is tied over the lower haptic, starting proximal to the optic (i.e., lower right 10-0 polypropylene) (k). Internalization of the lower haptic: the left hand is holding the extremity of the haptic with a McPherson forceps and pushing it inside in a clockwise movement while the other hand is pushing back the IOL’s optic with a vitreous spatula. Same manoeuver with the upper haptic; note the left hand which is pulling on the 10-0 polypropylene to guide the haptic under the iris plane (l).

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