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BRIEF COMMUNICATION
Year : 2017  |  Volume : 65  |  Issue : 8  |  Page : 750-751

Commentary: Comprehending haptic exteriorization in intrascleral haptic fixation of an intraocular lens


Narang Eye Care and Laser Centre, Ahmedabad, Gujarat, India

Date of Web Publication18-Aug-2017

Correspondence Address:
Priya Narang
Narang Eye Care and Laser Centre, Vijay Cross Roads, Ahmedabad - 380 009, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_489_17

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How to cite this article:
Narang P. Commentary: Comprehending haptic exteriorization in intrascleral haptic fixation of an intraocular lens. Indian J Ophthalmol 2017;65:750-1

How to cite this URL:
Narang P. Commentary: Comprehending haptic exteriorization in intrascleral haptic fixation of an intraocular lens. Indian J Ophthalmol [serial online] 2017 [cited 2020 May 26];65:750-1. Available from: http://www.ijo.in/text.asp?2017/65/8/750/213255



Since Gabor and Pavlidis [1] introduced the concept of intrascleral fixation of an intraocular lens (IOL), various techniques have been described in peer literature for the same. Glue-assisted intrascleral haptic fixation (glued IOL)[2] is one of the most popularized technique that has been further modified in its application and maneuverability.[3],[4] Handshake technique [5],[6] comprises the most essential component of performing the glued fixation as it facilitates haptic exteriorization by allowing the surgeon to assess the tip of the haptics for its safe withdrawal from the sclerotomy sites without creating a kink or a break in the externalized haptic.

Threading the haptics into the needle for facilitating exteriorization have been recently made quite popular with flanged haptic exteriorization technique.[7] The extraocular needle-guided haptic insertion technique (X-NIT) also comprises of threading the haptic into the 26-gauge needle and then placing a silicon stopper to prevent the haptic from slipping inside the eye. To prevent the haptic slippage, silicon tires of iris hooks have been used previously by Beiko and Steinert [4] in glued IOL surgery whereas Safran uses the small transversely cut pieces of intravenous tubing sets to thread the haptics.

In X-NIT technique, a 26-gauge needle is passed from the scleral site about 1.5 mm behind the limbus and the needle is extruded from the sclerocorneal wound. A probable distortion of the globe may occur by this maneuver as the wound is large, and the IOL haptic is threaded through this wound into the 26-gauge needle. A special mention is necessary to address the issue of threading the trailing haptic into the barrel of the needle, especially when the leading haptic has been externalized. To ease this, Yamane et al.[8] recommends not to externalize the leading haptic before the trailing haptic has been threaded into the lumen of the needle. This prevents counterclockwise rotation of the IOL, and the distance between the trailing haptic and the needle lumen is minimized facilitating threading of the trailing haptic.[7]

Nevertheless, it is essential to state that whichever technique the surgeon adopts it is very important that utmost care and precaution is taken, and the nuances of the surgical procedure are well understood and taken care of to optimize the visual outcome.



 
  References Top

1.
Gabor SG, Pavlidis MM. Sutureless intrascleral posterior chamber intraocular lens fixation. J Cataract Refract Surg 2007;33:1851-4.  Back to cited text no. 1
    
2.
Agarwal A, Kumar DA, Jacob S, Baid C, Agarwal A, Srinivasan S. Fibrin glue-assisted sutureless posterior chamber intraocular lens implantation in eyes with deficient posterior capsules. J Cataract Refract Surg 2008;34:1433-8.  Back to cited text no. 2
    
3.
Narang P. Modified method of haptic externalization of posterior chamber intraocular lens in fibrin glue-assisted intrascleral fixation: No-assistant technique. J Cataract Refract Surg 2013;39:4-7.  Back to cited text no. 3
    
4.
Beiko G, Steinert R. Modification of externalized haptic support of glued intraocular lens technique. J Cataract Refract Surg 2013;39:323-5.  Back to cited text no. 4
    
5.
Narang P, Agarwal A. The “correct shake” for “handshake” in glued intrascleral fixation of intraocular lens. Indian J Ophthalmol 2016;64:854-6.  Back to cited text no. 5
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6.
Agarwal A, Jacob S, Kumar DA, Agarwal A, Narasimhan S, Agarwal A. Handshake technique for glued intrascleral haptic fixation of a posterior chamber intraocular lens. J Cataract Refract Surg 2013;39:317-22.  Back to cited text no. 6
    
7.
Yamane S, Sato S, Maruyama-Inoue M, Kadonosono K. Flanged intrascleral intraocular lens fixation with double-needle technique. Ophthalmology 2017. pii: S0161-642032178-9.  Back to cited text no. 7
    
8.
Yamane S, Inoue M, Arakawa A, Kadonosono K. Sutureless 27-gauge needle-guided intrascleral intraocular lens implantation with lamellar scleral dissection. Ophthalmology 2014;121:61-6.  Back to cited text no. 8
    




 

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