Rectifying Suture Technique For Correcting Yamane Scleral-Fixated Intraocular Lens Malposition

Yamane technique of intrascleral haptic fixation may be complicated by tilt or decentration of the intraocular lens (IOL) due to asymmetrical scleral tunnel length and/or intrascleral tunnel angles. We describe a rectifying suture technique that helps to correct IOL tilt and decentration in such eyes.

Singapore National Eye Centre, Singapore.

Direction of optic tilt and decentration are assessed. A Kuglen hook is used to simulate the corrective effect on the haptic needed. This point is projected onto the sclera and marked. A bent 27-gauge needle traverses a short scleral tunnel before entering the globe posterior to the mark and haptic. A segment of 6-0 polypropylene suture is threaded into the needle and externalised. This process is repeated with the needle passing anterior to the scleral mark and haptic, resulting in the suture looped around the haptic. Suture tension is adjusted to achieve the desired corrective effect on the optic. The sutures are flanged and buried. This technique may be employed during the primary scleral fixation, or as a secondary procedure.

One corrective suture was adequate in 8 eyes, all of which were done primarily. In one of these eyes, the initial suture failed to loop around the haptic and the suture was repassed successfully but was complicated by vitreous hemorrhage. In 2 eyes, the rectifying suture was done as a secondary procedure. Corrective sutures around both haptics were inserted, of which one suture each had to be redone. The rectifying sutures were effective in achieving satisfactory IOL optic centration and minimization of tilt for all 10 eyes, with a mean follow up of 8.7 ± 8.0 months.

We describe a rectifying technique to correct IOL tilt or decentration following Yamane technique of IOL fixation, using a double flanged polypropylene 6-0 suture loop around the haptic.