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LETTER TO EDITOR
Year : 2001  |  Volume : 49  |  Issue : 4  |  Page : 277-8

Make it simple with the W1713 suture.


Correspondence Address:
M R Nair


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Source of Support: None, Conflict of Interest: None


PMID: 12930126

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Keywords: Ectopia Lentis, surgery, Humans, Lens Implantation, Intraocular, Lens, Crystalline, surgery, Suture Techniques,


How to cite this article:
Nair M R. Make it simple with the W1713 suture. Indian J Ophthalmol 2001;49:277

How to cite this URL:
Nair M R. Make it simple with the W1713 suture. Indian J Ophthalmol [serial online] 2001 [cited 2019 Dec 7];49:277. Available from: http://www.ijo.in/text.asp?2001/49/4/277/14684


  Dear Editor, Top


I read with interest the article "Scleral Suspention Pars-plana Lensectomy for Ectopia Lentis followed by Suture Fixation of Intraocular Lens" by Sandip Mitra et al in the June 2001 issue of the IJO. I had presented a paper on the same topic at the Kerala State Conference in 1998.

I felt that the surgical technique suggested by the authors was fraught with too many uncertainties to be considered safe and easy. Ideally a trans-scleral suture fixed lens should be placed in ciliary sulcus with a suturing technique that stabilizes the lens, induces no tilt and avoids the major arterial circle on its passage through the ciliary body.

The first step by the authors of introducing a curved needle (8 circle) through the sclera 1.5mm from the limbus is not suited to achieve ideal placement. Just as they say in cricket, a good batsman knows where his off stump is, so also in this type of suture placement one has to know the location of the needle tip throughout the placement process. So with a curved needle the position of the needle tip is always in doubt as the initial passage is done blindly, through the sclera-ciliary body and behind the iris. Introducing a 28G needle from the opposite side to railroad the curved needle into, does not assure safe and accurate exit of this suture from the opposite end. It is always possible for the curved needle to slip out from the 28G needle midway which means one may find a curved needle hanging in the middle. Additionally, guiding out the needle through a curved path through the sclera with a straight needle will cause more trauma. Wouldn't all this have been easier, accurate and safe by using a straight needle instead of a curved one? The Ethicon W1713 Suture (10.0 Prolene, double armed, straight needle 16mm length and 150 microns diameter) is ideally designed for such a placement.

Also, I fail to understand the advantage of having two 10/0 prolene sutures within the lens during lensectomy, which the authors claim to bring the lens to the pupillary area and stabilize it. The prolene suture surface is too smooth for it to cause any friction to drag the lens to any desired position and secondly as shown in the diagram (Figure 3 in the article) the prolene sutures may pass tangentially, so be of no use to pull the lens into the pupillary area. How would two sutures prevent lens droppings, which anyway could be easily managed since we have a parsplana approach? Further, during lensectomy isn't there a real risk of cutting these sutures whatever change in settings we make?

The procedure then involves an anterior capsulotomy and hydrodissection! With the procedure involving a pars plana lensectomy and the authors showing no inclination to have the lens capsule retained, why?

Regarding prophylactic peripheral laser retinopexy in all cases, to my mind, is an extreme step. Today prophylactic cryopexy even in lattice degeneration is not considered part of a preferred practice pattern.

Lastly, wouldn't it be better to raise the 3 and 9 o'clock scleral flaps like in trabeculectomy so that they can be sutured down protecting the scleral knot of the prolene suture than having the scleral flaps raised from the limbus and being unable to do so ?

Any surgical procedure should have the minimum of steps and maximum of effect. Though the authors have shown good results in 20 cases and are to be commended, any procedure that needs 6 entry points, a fragmatome, an endoilluminator and a laser is surely not a "simple technique".




 

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