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J.L. Ferreira, F. Vegini, C.R. Maliska; Clove hitch knot for scleral fixation of dislocated IOL – with temporary externalization of the haptics through a clear cornea incision. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):330.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:The strategy for repositioning a dislocated IOL (intra–ocular lens) into the vitreous cavity may change in face of each individual situation. Although the scleral fixation techniques are subject to complications, they can be minimized if blind manuvers are avoided. A simple technique to construct a clove hitch knot with the aid of the silicone tip of a 3 mm 20 gauge subretinal cannula is proposed. A temporary externalization of the haptics through a clear cornea incision is sugested as a secure and more controlled method with minimal riscs of injury to the haptics and to the retina. Methods:Two triangular, limbal based, 2 mm partial–thickness scleral flaps are placed in opposite sides avoiding the rectus muscles meridians. A pars plana vitrectomy is performed in order to provide IOL manipulation. A PFCL (perfluorocarbon liquid) may be used to protect the macula and also to facilitate the IOL repositioning. A 10–0 prolene (3/8, 0.65 cm curved needle) is inserted into the posterior chamber assisted by a 30 gauge needle through a puncture at the bed of the distal flap, 1 mm from the limbus. The suture is grasped with a Kelman–McPherson forceps from a clear cornea incision. A clove hitch knot is performed on a 3 mm silicone tip taken from a 20 gauge subretinal fluid cannula. At this stage the IOL haptic portion is grasped and temporarily externalized through the clear corneal incision. The haptic tip is inserted into the silicone tube and the clove hitch knot is transferred and tied to the haptic shaft. The same procedure is performed with the proximal flap suture and with the other haptic portion of the IOL. The outstaying curved needle is used for fixation suture and tied with a slipknot plus two conventional knots under each scleral flap. The scleral flap is then closed with a dissolving suture. Results:Twelve eyes of 12 patients, 4 women and 8 men, range 30 to 97 years of age, average 65 ± 19 SD, were submited to the procedure. The clove hitch knot did not scape from the haptics during the procedures and had an effective performance, considering the possibilities of lens tilt and decentration. Conclusions: This is an unexpensive, simple, controlled and secure method of repositioning a dislocated IOL. The clove hitch knot seems to be reliable in order to avoid lens tilt and decentration. The slipknot is important to optimize the outstaying sutures and to decrease the chances of astigmatism. Further work with selected patients must be analized.
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