April 12, 2019 Conference
When the capsule ruptures during cataract surgery, we can all agree that if vitreous prolapses forward, the first step is to perform a vitrectomy. But what should be done next? There is no consensus on the optimal IOL implantation technique in the absence of adequate capsular support, when an IOL cannot be safely placed within the capsular bag or in the sulcus. There are numerous options, including ACIOL placement, iris-fixation, and scleral-fixation, each of which has distinct advantages and challenges. This talk will briefly cover some pitfalls of using ACIOLs, including malposition, irregular astigmatism, corneal decompensation, and cystoid macular edema. Iris-sutured and scleral-sutured IOL fixation will then be reviewed, followed by a discussion of the sutureless scleral-fixation techniques known collectively as intrascleral haptic fixation (ISHF). These ISHF techniques include the glued IOL technique introduced by Agarwal and the double-needle flanged haptic technique introduced by Yamane. This case-based presentation will include several surgical videos.