EyeWorld India December 2014 Issue

December 2014 20 EWAP FEATURE Figure 1. Glued IOL Technique. (A) Three piece foldable IOL is injected through the corneo- limbal incision and the forceps through the sclerotomy is holds the leading the haptic. (B) Leading haptic is externalized under the scleral ap. (C) Both the haptics externalized. (D) Haptics tucked in the intralamellar scleral tunnel. Figure 2. (A) The end opening forceps is passed through the opposite sclerotomy site while another forceps is in the pupillary plane receives the haptic. (B, C) The forceps starts grabbing the haptic in adjacent position like a hand shake and this process is continued till the tip of the haptic is externalized. Figure 3. (A) Intralamellar scleral tunnel made with 26 G needle. (B) Haptic inserted into the tunnel. (C) Fibrin glue applied below the aps. (D) Anterior chamber is formed by air, corneal wound sutured and peritomy closed. Glued IOL: Fibrin glue assisted posterior chamber intraocular fixation in eyes with deficient capsules by Amar Agarwal, MS, FRCS, FRCOphth and Dhivya Ashok Kumar, MD I ntraocular lens implantation (IOL) in eyes that lack posterior capsular support has been a problem for cataract surgeons for a long time. It is not only due to the visual outcome but also to the related complications they face in the postoperative period. Historically, either an anterior chamber/iris claw or a suture scleral-fixated IOL has been implanted in eyes with deficient capsules. Glued IOL, a sutureless trans-scleral IOL fixation technique introduced by Dr. A. Agarwal in 2007 for posterior chamber IOL implantation eyes with deficient or absent capsules has shown good postoperative outcomes in the short and long term. Glued IOL Surgical technique Under peribulbar anesthesia, a localized peritomy at the exit site of the IOL haptics is performed (Figure 1). Two partial thickness limbus-based scleral flaps of approximately 2.5 x 2.5 mm are created exactly 180 degrees diagonally apart (using a scleral marker). An infusion cannula or anterior chamber maintainer is Figure 4. Decentered rigid posterior chamber IOL (A) repositioned y glued IOL method (B). Figure 5. (A) Intraoperative posterior capsular tear. (B) Two scleral aps made and anterior vitrectomy performed. (C, D) Glued IOL implanted behind the nucleus. (E, F) Remaining nucleus emulsi ed on the IOL. Source (all): Amar Agarwal, MS, FRCS, FRCOphth and Dhivya Ashok Kumar, MD inserted for infusion. Two straight sclerotomies with a 20-gauge needle are made approximately 1.0 to 1.5 mm from the limbus under the existing scleral flaps. A 3.0- mm corneo-limbal incision with a