Belt loop technique helps secure dislocated IOLs
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WAIKOLOA, Hawaii —Polypropylene sutures with a flange allow for secure scleral fixation of a dislocated IOL while giving support for a secondary IOL with minimal disruption to the conjunctiva, according to a speaker here.
In cases of in-the-bag IOL dislocation, Cathleen M. McCabe, MD, likes to use a “belt loop” technique to retain the lens while correcting its positioning. “This is really my go-to technique for an in-the-bag dislocation,” McCabe said at Hawaiian Eye 2022.
The belt loop technique is appropriate for all types of lenses and often helps avoid the need for anterior vitrectomy.
McCabe begins the procedure by marking 2 mm posterior to the limbus, 180° apart, to prepare for the placement of two belt loops.
“I bent a TSK thin-wall 30-gauge needle and put it through the conjunctiva and sclera, and then behind the optic, through the capsular bag, near the optic-haptic junction,” she said. She suggested using micro-forceps to assist in the maneuver.
“This is a section of 6-0 polypropylene suture cut at a bevel. That’s an important little tip to make it thread into the needle easier, pushing it forward as far as it will go,” McCabe said.
McCabe makes a large flange to ensure she does not accidentally grab the suture and pull it out.
Then, she takes the other end of the same piece of Prolene and inserts it into the anterior chamber, anterior to the previous placement and into the sulcus, making sure to be in front of the haptic. The other side of the same piece of Prolene is brought through the same paracentesis.
It is important to visualize the procedure to ensure as best as possible that the suture is around the haptic so the procedure does not need to be repeated, McCabe said.
“You want to kind of gently take the slack out. The first thing it does is elevate the IOL. By now, I’ve inflated the sulcus to put in that second pass, the IOL is sitting kind of posteriorly, and I wanted to elevate it back to normal position,” McCabe said.
She suggested trimming the flanges in order to make them easier to bury in the superficial scleral.
“Remove the viscoelastic,” McCabe said. “Now, the only incisions in this eye were small paracentesis, and there is no loss of vitreous. Really, this is a pretty atraumatic way of not having to exchange the IOL. I’ve done this in many, many cases, and it really is my go-to technique.”
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McCabe CM. Polypropylene solutions for dislocated IOLs. Presented at: Hawaiian Eye 2022; Jan. 15-21, 2022; Waikoloa, Hawaii.
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