EyeWorld Asia-Pacific March 2021 Issue

SECONDARY FEATURE EWAP MAR C H 2021 25 was centered, both sutures cut with flanges created to fixate the IOL in the desired centration (Figure 2c). If desired, the IOL- polypropylene complex can also be loaded into a cartridge and inserted into the eye through a smaller incision. IOL repositioning and fixation with 6-0 polypropylene For cases of in-the-bag IOL subluxation, the IOL can be repositioned and fixated to the scleral wall by passing a loop of 6-0 polypropylene around each IOL haptic. The 27-G needle enters the sclera 2 mm posterior to the limbus and receives one end of the suture from the space between the optic and haptic. This end of the suture was then externalized above the sclera. The same needle enters the sclera again at 1.5 mm from the limbus at the same radial axis to receive the other end of the suture above the IOL haptic. IOL centration can be titrated by adjusting the tension and length of this loop of suture which is wrapped around the haptic (Figure 3a). The same process was repeated for the opposite haptic with another length of 6-0 polypropylene. Flanges were created on the suture ends and were tucked under the conjunctiva (Figure b). The advantages of using 6-0 polypropylene for scleral fixation include the following: Figure 2 1. the thicker suture is more likely to resist degradation over time 2. it is conjunctival sparing 3. the inherent stiffness of the 6-0 polypropylene allows it to be controlled easily within the eye and surgery can be done without or minimal intraocular forceps/ instruments. 4. final IOL centration can be titrated easily by repeated shortening of the suture and flange creation. Despite the advantages, surgeons should pay extra attention to the size of the flange being created as a flange that is too large that is not sitting either within the scleral tunnel or flushed with the adjacent sclera may risk conjunctival erosion. In conclusion, I feel that the 6-0 polypropylene flanged fixation is technically simpler and faster than other sutured- fixation techniques and is a worthwhile addition to the armamentarium of scleral fixation techniques. EWAP Editors’ note: Dr. Wong is a consultant at National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, and declared no relevant financial interests. Figure 3 Source (all): John Wong, MD femto procedure, there is an issue of transporting the patient to the room where the phacoemulsification would then be performed. This requires some alteration to the flow of the surgeries, the femto part takes around 10 minutes approximately for each patient, so some ophthalmologists perform the femto part in 3 or 4 patients and then move them to do the phaco part later. Another point to note, there have been instances where the pupil came down in size leading to considerable miosis after femto. This suggests the release of prostaglandin analogues. This can be prevented by preoperative use of NSAID drops. For any technology to survive and excel it has to be affordable for the patient and also profitable to the users. We hope that in future both the size of the laser machine and the price will come down so that all ophthalmologists who have a phaco machine will have the opportunity to use FLACS. We further hope that the femto machine becomes compact and can be placed below the operating microscope or below the operating table, so all ophthalmologists can use this wonderful technology. EWAP Editors’ note: Dr. Anwar is assistant professor at Bangladesh Eye Hospital and Institute and declared no relevant financial interests. Femto in cataract surgery: Future or frustration? - from page 23