Eyeworld

34 | EYEWORLD | FALL 2025 ATARACT C original technique was developed by Sergio Canabrava, MD. This uses 6-0 or 5-0 Prolene to loop the haptics and use cautery. Dr. Hart said he uses this technique but infrequently because he has concerns about erosion and whether the suture is going to hold up long term. However, when he has done the technique, it works. "It requires a little less dissection of the conjunctiva, but the other issue is the wound leak tends to be more common, and getting the right tension on sutures is more difficult. "With sutures, Gore-Tex particularly, I'm able to adjust suture tension so the implant is better centered and not too tight and not too loose, which is very important," Dr. Hart said. He also noted the Yamane technique of intrascleral haptic fixation from an anterior segment approach and added that some retina colleagues perform a similar technique. This requires a 3-piece lens and haptics brought into the sclera, and the ends of the haptics are cauterized. "If there's no zonular or capsular support, I do a Yamane technique," he said. If there's adequate capsular or zonular support, putting a lens in the bag is still the way to go or putting it in the sulcus if you can't put it in the bag, Dr. Hart said. Dr. Hart said he will generally try to use the lens that's already been working in the eye, as these problems are usually structural and not the fault of the lens. "Part of the problem is that anything that goes into the ciliary sulcus, you have to use a 3-piece lens because 1-piece lenses can cause UGH syndrome, and you don't want to leave the patient with a potentially sight-threatening complication that you creat- ed," he said. To learn these techniques and to keep your skills fresh, Dr. Hart said there are wet labs on secondary IOL fixation at major meetings, in- cluding the American Academy of Ophthalmolo- gy Annual Meeting and ASCRS Annual Meeting. "Most of the people who do this on a regular basis are willing to teach," he said. Potential concerns Dr. Hart said that all of these techniques have risks, including the risk of CME, retinal detach- ments, or retinal tears. When you're working Additionally, he noted the issue of dead bag syndrome, a more recently described term for when the lens capsule doesn't seal around the implant, and all of the cells that would normal- ly be involved with sealing, the lens epithelial cells, die off. The lens is rattling around inside the capsular bag, Dr. Hart said. When you have a dead bag, the lens can erode through the capsule. If that happens, the lens needs to come out, and you'll need an entirely new way to fix- ate it. "Often those lenses with dead bags have bad zonules, so you can't necessarily depend on the capsule or the bag for continued support." While Dr. Hart said he has used iris fixation in the past, he doesn't use this technique as much anymore because of the higher incidence of CME. "Now, predominantly, if it's an in-the-bag IOL dislocation, I will suture to the sclera with Gore-Tex right through the capsule to the hap- tics." He noted that you could also use 10-0 or 9-0 Prolene, but he finds these more prone to break over time. Another option is the belt loop technique, Dr. Hart said, adding that this technique was coined by Cathleen McCabe, MD, and the continued from page 32 continued on page 36 In-the-bag IOL dislocation of a single-piece acrylic IOL Source: John Hart Jr., MD

• Blank Page
• Blank Page (1)