Transconjunctival Intrasceral IOL Fixation with a Modified Double-needle Technique Using a Posterior Segment Approach



To improve our technique of scleral fixating intraocular lenses by describing a modification of Shin Yamane’s double needle iol fixation technique that can be applied to posterior dislocated three piece lenses.


A complete ppv is perform. The three piece intraocular lens is then mobilized until it sits freely on the macula. A large bore 30 gauge needle is then inserted into the vitreous at the 3 o’clock meridian 1.5 mm posterior to the limbus.  Under chandelier illumination, the inferior lens haptic is grasped with intraocular forceps and the end is inserted 3 mm into the 30 gauge  needle.  The needle is handed of to an assistant. A second 30 gauge needle is then inserted 180 degrees opposite the first needle.  An intraocular forcep is then used to feed the superior haptic into the 30 gauge needle.  Both needles are removed at the same time exposing both haptics.  Using a hot cautery, the tips of the haptics are heated to create a flange.  The haptics are then guided back into the sclera where the flange prevents further movement with in the sclera allowing for stable centration.


In all patients, the combined implant was well fixated in the sulcus and appeared stable.  No significant tilt was noted.


This technique allows for stable fixation of a dislocated three piece lens without the need to stabilize the lens in the anterior chamber.  It tends to be simpler than other standard approaches to scleral fixation such as sutures or flaps or larger tunnels.  While all surgical techniques have potential complications, this technique appears well tolerated and can be learned relatively easily.


Richard H. Johnston
Edina, United States
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