| 본문 : Managing posterior segment complications of intraocular lens (IOL) surgery has become an increasingly important responsibility of the retinal surgeon. The purpose of this study is to demonstrate our technique of scleral IOL fixation using 9-0 polypropylene and to share pearls.
After performing a pars plana vitrectomy, two partial thickness scleral grooves, 2 mm posterior to the limbus with 180° apart position, is created using Beaver blade (Beaver-Visitec, Waltham, MA, USA). A straightened needle of 9-0 polypropylene mono-armed suture (Prolene, Ethicon, Somerville, NJ, USA) is passed through the scleral groove and the bent 26-gauge hollow needle is then entered through the other scleral groove. After the needle is docked into a 26-gauge needle, the needles are withdrawn. As using a 26-gauge needle, the polypropylene suture needle can be railroaded and brought out. After making two 2.75-mm clear corneal incisions, the suture is pulled through the corneal incision using a Sinskey hook and then cut into two. One of the 2 pieces of the suture is withdrawn through the opposite corneal incision using a McPherson forceps. A 3-piece IOL is inserted through the one of corneal incision with an injector. At this time, the leading haptic is on the iris opposite the IOL insertion site. The opposite haptic is placed on the outside through the IOL insertion site. The leading haptic is withdrawn through the adjacent corneal incision with a McPherson forceps. Before the haptics are pushed back, the tips of haptics are cauterized to create a terminal knob using thermal cautery unit (Accu-Temp, Beaver-Visitec). Then the previously passed sutures are passed as a loop through the haptic and tied securely to each haptic, 1.0 mm from the haptic tip. After both haptics are implanted behind the iris, the two sutures are pulled and tightened. After IOL centration is confirmed, each polypropylene suture was tied in the scleral groove ensuring centration of IOL, and the suture knot is left long enough to prevent exposure of the knot. The suture knots are buried under the tenon, and the incised conjunctiva is repaired with an 7-0 vicryl suture.
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