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EW NEWS & OPINION 17 the tip of the haptic with the for- ceps, you can easily do so and then start injecting the IOL when the tip is already grasped. Exteriorization The exteriorization of the haptics is a key step in the glued IOL tech- nique. Through the sclerotomy under the scleral flap, 23-gauge for- ceps or any end-opening forceps are introduced. Assuming the injector utilizes a pushing mechanism, as the surgeon starts injecting the IOL into the AC with one hand, the tip of the haptic is caught with the forceps and exteriorized with the other hand while injection continues very gently. The injector is then slowly with- drawn so that the trailing haptic passes through the wound outside the globe. The leading haptic should be grasped at its very tip so that it doesn't get snagged at the sclero- tomy during the withdrawal. The leading haptic, which has been grasped with the forceps, is thus ex- teriorized through the sclerotomy. It is then held firmly by an assistant so that it doesn't get drawn back into the vitreous cavity during subse- quent maneuvers. Alternatively, George Beiko, B.M., B.Ch., F.R.C.S.C., assistant professor of ophthalmology, McMaster Univer- sity, Canada, uses the sponge tire of an iris or capsule retractor and plugs it onto the haptic so that an assis- tant is not required to hold the hap- tic. The handshake technique If one of the haptics is not caught or if it gets released accidentally, the surgeon needs to be familiar with the handshake technique as a means of transferring the haptic from one hand to the other. This is also useful if one is using a screwing mecha- nism injector where both hands are occupied. The technique utilizes two forceps, one of which holds one haptic. Depending on ease of access, the other forceps is introduced through the opposite sclerotomy or through the side-port. The first hand then transfers the haptic into the second forceps such that the first hand now becomes free. It is essential to hold the haptic at its tip before exteriorizing it so that it doesn't snag on the sclero- tomy while being brought out. For this reason, this handshake transfer of the haptic between the two for- ceps is continued until the tip of the haptic is caught by the forceps on the side where the haptic is to be exteriorized. This technique allows for easy intraocular maneuvering of Leading Innovations in Ophthalmology Moria Inc, 1050 Cross Keys Drive, Doylestown, PA 18902 1-800-441-1314 • moria@moriausa.com • www.moria-surgical.com The Moria system for creating ultra-thin planar corneal lamellar grafts g n i d a e Le s n o i t a v ov n n I g o l o m l a h t h p O n i y g g p y g h T e r c r o f e i t a e M i r o a e t s y s g n i l u r t - a i h t m e n planar n r o c e a e l a l m a l l e r g ft gra t f s Moria Inc, 1050 Cross Keys Drive, Doylestown, PA 18902 1-800-441-1314 • moria@moriausa.com • www.moria-surgical.com Moria Inc, 1050 Cross Keys Drive, Doylestown, PA 18902 1-800-441-1314 • moria@moriausa.com • www.moria-surgical.com Moria Inc, 1050 Cross Keys Drive, Doylestown, PA 18902 1-800-441-1314 • moria@moriausa.com • www.moria-surgical.com Scleral tunnel made with 26 G needle. Haptic end tucked into the tunnel Handshake technique for glued IOL Fibrin glue placed below the flap. Flap apposed with the scleral bed Multifocal glued IOL Source: Amar Agarwal, M.S., F.R.C.S., F.R.C.Ophth. continued on page 18 June 2011

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