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BLOG: Triumvirate technique
The triumvirate technique comprises three techniques that are performed sequentially to optimize the visual outcome following a posterior capsular rupture with sinking nuclei in deficient capsular support. It comprises a modified posterior assisted levitation, or PAL, with IOL scaffold and glued IOL fixation.
The video showcases the incidence of posterior capsule rupture with sinking nucleus into the vitreous cavity. As in glued IOL surgery, two partial-thickness scleral flaps are made followed by sclerotomy with a 22-gauge needle beneath the flaps. These sclerotomy sites are used for performing a PAL, and as PAL is not performed from a pars plana route but is instead performed from these sclerotomy sites, the procedure is known as modified PAL. Another advantage is that as two sclerotomy sites are there, both sites can be used for levitating the sinking nucleus into the anterior chamber. An IOL scaffold procedure is performed by injecting a three-piece foldable IOL beneath the nuclear fragments, which are emulsified with the phacoemulsification probe. Vitrectomy is performed, and all the cortical matter is removed from the retropupillary area. As the sulcus support is deficient, the haptics of the IOL are externalized from the sclerotomy sites and tucked into the scleral pockets followed by glue application.