This article is more than 5 years old. Information may no longer be current.
Pearls for iris-sutured IOLs
Click Here to Manage Email Alerts
 A three-piece IOL has been sutured to the back of the iris. |
When I first saw the Siepser knot (and the Osher modification of it) being used to suture an IOL to the back of the iris, I knew that this was a technique that I had to learn. It's quite elegant — with a minimally invasive technique, a three-piece IOL can be sutured to the back of the iris in eyes in which there is insufficient capsular support.
Here are a few pearls that I use when teaching residents this technique:
1. The Siepser knot is easy to learn, but understand the mechanics first by practicing with shoe-laces, twine or string.
2. Pass the suture through the mid-iris tissue and not at the pupillary margin. And make the sutures even for both haptics and placed 180° apart.
3. Use micro-forceps or micro-graspers to pull the iris tissue and create a round pupil before tightly cinching down the knots.
4. Use your normal "in-the-bag" IOL power calculations since the IOL will tend to sit back further than a true sulcus-fixated IOL.
And finally, give yourself enough time to perform this surgery — it will take significantly longer than your usual cataract surgery. When you see the patient at the slit lamp and the IOL is well-positioned and the patient has good vision, it'll all be worth it.