|Year : 1972 | Volume
| Issue : 3 | Page : 130
Episcleral limbal fixation suture for cataract surgery
King Edward Memorial Hospital, Bombay, India
S D Adrianwala
King Edward Memorial Hospital, Bombay
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Adrianwala S D. Episcleral limbal fixation suture for cataract surgery. Indian J Ophthalmol 1972;20:130
The success of a cataract operation depends to a large extent on the incision. For those surgeons who use the Graefe knife for incising, timbal fixation of the eyeball often poses certain problems which could be minimized or altogether avoided by the use of a fixation suture instead of a fixation forceps.
Disadvantages of fixation forceps: The majority of surgeons use a multiple toothed T fixation forceps. With this forceps, the conjunctiva often gets torn during the incision and the smooth continuity of a knife section is interfered with at the moment when the fixation grip is altered, by the tearing of the conjunctiva. Sometimes a subconjunctival haemorrhage occurs. Attempts at refixation, after the conjunctiva tears are often futile and one has then to resort to fixing the eyeball by holding the tendon of insertion of the medial rectus muscle. This fixation near the point of counter puncture hinders the to and fro movements of the Graefe knife.
A fine one into two teeth forceps of Castroviejo is used by some surgeons to fix the eyeball. This has lesser chances of tearing the conjunctiva but the eyeball wobbles more during incision. We therefore first tried a fixation suture at the 6 O'clock position to fix the eyeball.
Procedure: A superior rectus suture is essential when a fixation suture (or sutures) is used, in order to prevent wobbling.
A deep episcleral suture with 4 x 0 silk is passed at 6 o'clock, or preferably 2 sutures are taken at 4 o'clock and 8 o'clock which together with the superior rectus suture, enable a triangular fixation of the eyeball.
These sutures can be held by the assistant so that during incision, the other hand of the surgeon is free. This is of tremendous advantage if one uses a preplaced suture and if the assistant is new and not used to the surgeon's requirements. A fold of conjunctiva which often appears at the point of counterpuncture can be moved away by the surgeon himself and the ends of the loop of the preplaced suture near the limbus can be moved away by the surgeon while incising with the other hand.
An important precaution is to remove the fixation suture immediately after the incision is complete. Otherwise an inadvertent pull on these sutures by the assistant may suddenly raise intra ocular pressure and press on the vitreous.
Summary of Advantage of Deep Episcleral Limbal Fixation Sutures Over Fixation Forceps
- Tearing of the conjunctiva does not occur.
- Chances of subconjunctival haemorrhage are reduced.
- Eveness of fixation throughout the incision is maintained and thereby a smooth incision without serrations is ensured.
- The other hand of the surgeon is free during the incision.
- Reliance on the assistant during incision is absolutely minimized.