Eyeworld

C to rule out any IOL damage and determine if the patient needs a vitrectomy. There are some single-piece IOLs that you can refixate, she said, adding that she likes to use a belt loop technique, which she noted is described in depth by Cathleen McCabe, MD. Dr. Rocha will use 6-0 Prolene with this technique and scleral fixation. She then loops the IOL haptics to the scleral wall. If the patient has a three-piece IOL in the eye, one technique that is popular is the Yamane technique, Dr. Ro- cha said. She uses a toric marker at 6 and 12 o'clock and a secondary mark 2.0 mm from the limbus. Two angled scler- al tunnels are made parallel to the limbus at the marked lo- cations using two needles; she uses either a 30-gauge TSK ultra-thin wall needle for the CT LUCIA lens (Carl Zeiss Meditec) or a 27-gauge needle for the AR40E SENSAR IOL (Johnson & Johnson Vision). She then feeds the needles using micro-forceps and pulls the haptics. 1 Using a glued IOL was described many years ago by Amar Agarwal, MD, Dr. Rocha said, mentioning this as another option. Choosing a technique depends on the IOL type. If the patient has a PMMA lens, this has a little hole that you can move and perform a scleral fixation with either 6.0 Prolene (the belt loop technique) or Gore-Tex CV-8. Another option is iris fixation, but she said she's "not a big fan because we usually see a lot of pigment dispersion and sometimes CME." With a three-piece IOL, you can do iris suture/iris fixation, if you're using the same lens, she said. If the whole lens complex is dislocated but the lens is in the bag and looks like it's a good lens, Dr. Safran said he will lasso the whole lens bag complex. He uses Gore-Tex su- tures with a lasso in these cases. In most of these patients, Dr. Safran said he will also do a vitrectomy. "If you don't do the vitrectomy, you can get burned," he said. It's easy to in- advertently engage vitreous when passing a suture through the capsular bag and bring vitreous forward into the ante- rior segment, he explained, emphasizing the importance of avoiding vitreous traction to the lens or sutures. Dr. Chee discussed using a lasso technique and said she creates belt loops around the haptics of the IOL either with or without a CTR only if they are still within the capsu- lar bag. "I use either Prolene 6-0 suture with the McCabe technique or Gore-Tex CV-8 suture (which is off label for ophthalmic use) using the suture snare technique, employ- ing Hoffman pockets," she said. For both the McCabe and suture snare techniques, Dr. Chee said she uses a 27-gauge needle to pierce the capsular bag to lasso the haptic. "I use a capsulorhexis micro-forceps to grasp the capsular bag to position it when piercing with the needle," she said. These continued on page 50 Look to Stephens for single-use instruments. I N S T R U M E N T S | S I N G L E U S E | D R Y E Y E | B I O L O G I C S Stephens Instruments | 2500 Sandersville Rd | Lexington KY 40511 USA Toll Free ( USA ) 800.354.7848 | info@stephensinst.com | stephensinst.com © 2020 Stephens Instruments. All rights reserved. SAVE TIME & MONEY Removes hidden costs of time and resources spent on prep, cleaning, sterilization, repair, and replacement. REDUCE RISK Reduces risk of cross contamination. Overall improved safety for patients and staff. ! $ SafeSite ™ Sterile Single-Use Instruments

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