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Publication Exclusive: Anterior sclerotomy used for adequate haptic externalization in glued IOL surgery

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IOL implantation is an essential step for visual rehabilitation in cataract surgery or in cases of secondary IOL placement. When the IOL is placed within a capsular bag that is supported by the zonules 360° during cataract surgery, the IOL is usually in an acceptable and relatively stable position. However, in the absence of a posterior capsular bag, alternative approaches to IOL placement will be necessary.

These alternatives include anterior chamber placement of an anterior chamber IOL, iris-sutured IOL, ciliary sulcus placement of a posterior chamber IOL, scleral-supported posterior chamber IOL that includes the use of sutures, or scleral pocket-supported glued IOL. When placing an IOL in the anterior chamber or ciliary sulcus, the overall IOL length and the relative dimensions of the anterior chamber and ciliary sulcus are important considerations for a stable IOL implantation. This is less critical with an iris-sutured IOL placement, but mechanical rubbing of the IOL haptic against the iris should be prevented in such cases. In a scleral-fixated posterior chamber IOL using sutures, the suture length can be adjusted to compensate for the required optimal placement.

When using a scleral pocket to tuck a secondary IOL, the total length of the externalized haptic becomes important for long-term stability. Because the haptic length is fixed in the chosen IOL, the overall dimensions of the anterior segment of the eye and the relative haptic exit point from the interior of the eye will determine the total length of the externalized haptic that can then be tucked within the scleral pocket. Shorter length of an externalized haptic can have a negative impact on IOL stability postoperatively.

In this column, Drs. Agarwal and Narang describes a useful technique to compensate for variations in the anterior segment size of the human eye and obtain adequate length of the externalized IOL haptic for a scleral pocket-housed glued IOL.

Thomas “TJ” John, MD, OSN Surgical Maneuvers Editor

Click here to read the full publication exclusive, Surgical Maneuvers, published in Ocular Surgery News U.S. Edition, August 25, 2015.