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27-gauge needle technique reduces sclerotomy size, eases haptic extraction
Sutureless intrascleral IOL technique improves fixation, wound closure.
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Sutureless intrascleral fixation techniques can pose complications and risks, particularly in eyes with inadequate capsular support.
Close proximity of the sclerotomy and scleral tunnel complicates IOL insertion, and a discrepancy in sclerotomy diameter and IOL haptic can lead to postoperative wound leakage and hypotony, Shin Yamane, MD, and colleagues said in a study in Ophthalmology.
To circumvent these risks, Yamane and colleagues developed a sutureless 27-gauge needle-guided IOL implantation technique.
“I wanted to minimize the sclerotomies,” Yamane told Ocular Surgery News in an email interview.
Yamane drew from two prior IOL surgery methods to develop this technique.
“I combined Gabor’s sutureless technique and Lewis’ ab externo technique,” Yamane said. “Externalization of the trailing haptic was difficult. I developed the ‘double-needle technique’ to solve the problem.”
Key steps
“This technique requires no special instruments for the IOL fixation and provides good IOL fixation with good wound closure without leakage,” Yamane and colleagues said in the study.
A complication of prior intrascleral fixation techniques is the close positioning of the sclerotomy to the scleral tunnel. That nearness impedes the insertion of the IOL, they said.
“In our technique, the vertical dissection is made so that the sclerotomy for the haptic externalization is further apart from the scleral tunnel. As a result, the haptic is easily grasped and introduced into the scleral tunnel,” they said.
Yamane and colleagues use two 27-gauge needles to extract the haptics.
When 22-, 24- or 25-gauge needles are used to create sclerotomies, the tunnels created to externalize the IOL haptics are too large, resulting in a discrepancy between the size of the sclerotomy and the IOL haptic, causing wound leakage and hypotony, Yamane and colleagues said.
The dimensions of 27-gauge needles provide better operability and easier externalization of the IOL haptics, they said. With an outer diameter of 0.4 mm, the needles are small enough for the “self-sealing of the angled sclerotomy.” With an inner diameter of 0.22 mm, the needles are large enough to install the IOL haptics.
“Our double-needle technique has resolved this problem by using two needles for externalizing the haptics,” they said.
By threading the second haptic first, Yamane and colleagues overcome the technical challenge of having to thread the second haptic. The first haptic is not externalized until the second haptic is looped into the second needle, precluding the possibility of counterclockwise rotation of the IOL, they said.
Advantages
So far, Yamane and colleagues have performed 70 IOL implantations with this technique.
“The advantage of this technique is the smallest sclerotomies for haptic externalization,” Yamane said. “Smaller incisions may reduce surgical complications.”
Yamane noted some drawbacks as well.
“It is difficult for beginners to insert the haptics into the needles,” Yamane said. “They must consider the position of the sclerotomies (for IOL insertion and haptic externalization). Simulation before surgery may help in understanding the best positions.”
Nonetheless, Yamane and colleagues view the 27-gauge double-needle-guided technique as a potent addition to posterior chamber IOL implantation methods with notable advantages over other sutureless techniques.
“Our 27-gauge needled-guided intrascleral posterior chamber IOL implantation technique should be useful for IOL implantation in eyes without sufficient capsule support,” they said. – by Steve Ahern