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We will be presenting on knotless scleral fixation of luxated foldable IOLs and for secondary implantation in aphakic eyes in eyes without zonular support. This technique provides the advantage of avoiding iris manipulations, is perfomed through a small corneal incision and does not require the need to order or stock special IOL types. Furthermore, it is cost effective, involves standard IOL calculation formula and is associated with good long-term IOL centration and stability.

Methods:

Since 2007, the surgical steps performed in all cases were: vitrectomy and implantation of a foldable IOL through a small clear corneal incision and fixation to the sclera. To secure the implant, a knotless technique was performed. First, a bow on each haptic is done using a 10-0 polypropylene double-armed suture; second, both needles are passed through the sclera, 1.5 mm from the limbus and 180ยบ apart. Subsequently, the folded IOL is inserted using a forceps and is positioned in the ciliary sulcus. The implant is then secured with five intrascleral bites in a zig-zag fashion. The two sutures are cut without the need for tying any knot.

Effectiveness:

This technique was used in more than 100 cases with insufficient or no capsular support. We found very low rates of complications, good long-term IOL stability and it was associated with rapid visual rehabilitation.