This article explains a technique of scleral fixation of intraocular lens (SFIOL) by using a 30-gauge (g) needle.
Background: The X-nit needle by "Aurolab" uses a 26-g needle, while in this technique, a 30-g needle is used, thus reducing the incision size and relevant complications.
Purpose: In this technique, glue or end-gripping forceps are not used, thus making it hassle free and more economical. There is no dependency on assistant; because of using 30 g needle, bleeding is minimal and wound healing is faster.
Synopsis: A 30-g needle is bent at 3/4-1/4 junction (from the tip) and a piece of 240 silicon band is inserted into the needle to be used as a stopper. After completing vitrectomy, a 1.5-mm marking is done perpendicular to the limbus at 3'o clock and 9'o clock positions. Another marking is done 1.5 mm away from the first mark parallel to the limbus. A 30-g needle is inserted into partial-thickness sclera from the second mark toward the first marking, thus making a tunnel. The needle is penetrated into the sclera to enter in the vitreous cavity. The needle is then progressed toward the anterior vitreous cavity and brought out through the lip of previously made scleral tunnel in the superior quadrant. The tip of leading haptic of three-piece intraocular lens (IOL) is fed into the tip of needle and gradually, the needle is withdrawn. As soon as the tip of needle is visualized, the piece of band is gradually slipped into the haptic and the needle freed from the haptic. In a similar fashion, the trailing haptic is withdrawn from the opposite side. The bands are removed and the haptics are adjusted by pulling or pushing to centralize the IOL in the pupillary axis. Haptics are trimmed and ends are cauterized to make them blunt. Tunnel and conjunctiva are sutured with one or two (8-0) absorbable Vicryl sutures. The 25-g ports are removed and no suturing of ports is done.
Highlights: It is a minimally invasive and glueless technique in which end-gripping forceps is not used. So, it is very economical with faster wound healing and minimal bleeding and no post-op hypotony. Since the temporal scleral flaps are not made and 30 g needle is used so minimal invasive. Astigmatiam induced by scleral tunnel is seen i;e about 0.75- 1.15 D of cylinder.
Video link: https://youtu.be/1msuS5KySOk.
Keywords: 30 gauge; intraocular lens; scleral fixation of IOL.