IOL can be sutured to iris in patients with inadequate capsular support

NAPLES, Italy — In patients with inadequate capsular support, the IOL can be implanted in the anterior chamber, suturing the haptics to the peripheral iris, according to a lecturer here.

In the Gian Battista Bietti Medal Lecture at the joint meeting of Ocular Surgery News and the Italian Society of Ophthalmology, Walter J. Stark, MD, said, "This technique can be accomplished through a 3.5-mm incision. The pupil is constricted with acetylcholine, and the IOL is folded and inserted through the corneal wound, placing the haptics within the sulcus and positioning the optic above the plane of the iris."

In the technique, a Barraquer sweep is passed through the paracentesis and placed beneath the optic as the lens is unfolding, he said. Additional viscoelastic is injected into the anterior chamber to push the iris posteriorly against the haptics, while the optic is lifted by the Barraquer sweep.

The haptics are tied to the peripheral iris using a modified McCannel-type iris-fixation technique, with a needle and a 10-0 polypropylene suture, Dr. Stark said. Then, the optic is placed posterior to the iris.

"This technique permits secondary IOL insertion in aphakic patients who are contact lens intolerant, facilitates the management of IOL problems after surgery that require IOL exchange and allows the surgeon to treat patients who develop loss of capsule support at the time of cataract surgery," Dr. Stark said.