Фиксация ИОЛ с помощью шва радужной оболочки

This is a video shared by Dra. Fabiana Gonçalves from Recife - Brazil In this case a 3-pieces IOL was dislocated to the vitreous cavity after complicated cataract surgery and loss of adequate capsular support. In the beginning of the vitrectomy, a small bubble of Perfluorocarbon liquid is injected above the macula to protect the posterior pole. Then, after removing all the vitreous, the surgeon uses a retinal forceps to bring the IOL into the anterior chamber and one of the haptics are externalized through a corneal incision. Iris suture IOL fixation was programmed in this case using 10-0 prolene sutures with curved needles. First the inferior haptic is sutured using McCannel technique. The needle is inserted into the anterior chamber through a corneal incision, passes through the mid periphery of the iris and behind the haptic and it is externalized in the other side of the iris, and out of the cornea in the limbus . On the first attempt however, the suture passed behind the iris but did not involve the haptic. So the suture was removed and a iris spatula was used to lift the IOL optic and to create an haptic indentation. This way it is possible to better outline the haptic footprint. Another tip that can make it easier to engage the haptic, is passing the needle toward the concavity of the haptic and not against it. In the McCannel technique, after passing the suture, a paracentesis is created at the midpoint of the throw. Then, both suture ends are gently externalized in a "rabbit-ear" fashion. The ends are tied in a 3-1-1 fashion to suture the first haptic. At this moment, a miotic agent can be used to constrict the pupil. The spatula is used again to help the positioning of the second haptic behind the iris and to keep the optical zone of the IOL captured by the pupil. Then the second haptic is sutured superiorly following the same steps. Finally the optical zone of the IOL is placed in the retropuppilar position and the PFCL is removed Author:  Fabiana da Fonte Gonçalves MD Recife - Brazil Edition:  Filipe Lucatto MD Juliana Prazeres MD Salvador - Brazil