4-Flanged intrascleral fixation of an intraocular lens through the dialing hole

The high prevalence of mature, hypermature, and traumatic cataracts in developing countries, combined with the limited availability of surgical resources and skill by anterior segment surgeons to manage the resultant aphakia, leaves the patient needlessly blind. Relying on posterior segment surgeons, expensive surgical setup, and appropriate lenses for aphakia management limits the number of patients receiving a secondary intraocular lens (IOL). Utilizing the well-acknowledged flanging technique and the readily available polymethyl methacrylate (PMMA) lenses with dialing holes in their optic, a hammock can be created through the dialing holes using a 7-0 polypropylene suture on a straight needle. This 4-flanged scleral fixation through the dialing hole of an IOL makes scleral fixation of PMMA lens possible by even anterior segment surgeons without requiring any specialized equipment or scleral fixated lens with eyelet. This technique was successfully performed in a series of 103 cases with no incidence of IOL decentration.

A novel transconjunctival, intrascleral, ab-externo, knotless, and double-flanged technique with 6-0 Prolene for iridodialysis repair

Small traumatic iridodialysis (ID) may be asymptomatic, but large ones usually cause polycoria and corectopia, leading to symptoms like diplopia, glare, and photophobia. The management of ID, including medical and surgical methods, depends upon the patient’s symptoms. Mild glare and diplopia can be treated either with atropine, antiglaucoma medications, tinted spectacles, colored contact lens, or corneal tattooing, but extensive IDs require surgical options. The surgical techniques are challenging due to the iris texture and the damage encountered during the primary surgery, the narrow anatomical workspace for repair, and the associated surgical complications. Numerous techniques have been described by several authors in the literature; each has its advantages and disadvantages. All the procedures described previously involve conjunctival peritomy, scleral incisions, and suture knots and are time consuming. Here, we report a novel transconjunctival, intrascleral, knotless, and ab-externo, double-flanged technique for repair of large ID with a 1-year follow-up

Single haptic iris fixation of posterior chamber intraocular lens

Single haptic iris fixation technique is used where there is a loss of 6 clock hours anterior capsular support. It helps the anterior segment surgeon to fix the intraocular lens to the iris on the side of absent capsular support and place the other haptic over the capsular support. A 10-0 polypropylene suture on a long-curved needle is only used to take a suture bite on the side of capsule loss. Meticulous automated anterior vitrectomy is done. Then, the suture loop below the iris is taken out and the loops are twirled multiple times around the haptic. The leading haptic is then gently glided behind the iris, and the trailing haptic is gently placed on the other side using forceps. The suture ends are trimmed and internalized into the anterior chamber and then externalized through the paracentesis using a Kuglen hook, and the knot is tied and secured