The Stopper Knot Technique For Scleral Intraocular Lens Fixation
Published 2026 - 44th Congress of the ESCRS
Reference: POCAT058 | Type: Case Report | DOI: 10.82333/eav0-vb96
Authors: Dr Roberta Kern Menna Barreto* 1 , Dr Rafael Tristão 1 , Dr Sérgio Cruz 2 , Dr Luiza Zimmermann 3 , Dr Pedro Menna Barreto 4 , Dr Vitor Menna Barreto 4 , Dr Flávia Zandonadi S. Carvalho 5 , A/Prof. Bruno Teno 1 , A/Prof. Gabriel Figueiredo 6
1Cataract & Glaucoma,PhacoBrazil,São José do Rio Preto,Brazil, 2Banco de Olhos de Sorocaba,Sorocaba,Brazil, 3Santa Casa de São Paulo,São Paulo,Brazil, 4Menna Barreto Clinica de Olhos,Porto Alegre,Brazil, 5Seumed Hospital de Olhos,Maringá,Brazil, 6PhacoBrazil,São José do Rio Preto,Brazil
Purpose
To describe transscleral fixation of a three-piece intraocular lens using Gore-Tex® (expanded polytetrafluoroethylene, ePTFE) sutures with the Stopper Knot technique.
Setting
Tertiary public referral center within the Brazilan Unified Health System (SUS) in São José do Rio Preto, São Paulo, Brazil.
Report of case
A patient with a dense cataract underwent phacoemulsification complicated by posterior capsule rupture with loss of capsular support. Due to intraoperative instability, the eye was intentionally left aphaic to allow ocular stabilization and staged surgical planning.
One month later, secondary scleral fixation of a three-piece IOL was performed. After pars plana anterior vitrectomy to ensure complete anterior chamber vitreous removal, two partial-thickness scleral pockets were fashioned 180 degrees apart. Two Gore-Tex® (CV-8, ePTFE) sutures were externalized through the sclera. The first suture was tied to one haptic and gently tensioned. The second suture was then tied to the opposite haptic and tensioned to achieve optimal IOL centration and stability. Only after satisfactory centration was confirmed tha stopper knots were created at the scleral exit sites to secure fixation. The knots were buried beneath the scleral pockets to provide mechanical protection and reduce the risk of conjuntival erosion.
At one month, best-corrected visual acuity was 20/20 with manifest refraction of -0,50 -1,00 x 100º. The IOL was well centered without tilt or decentration. No hipotony, inflammation, cystoid macular edema, or suture-related complications were observed.
Conclusion/Take home message
Transscleral fixation of a three-piece IOL using Gore-Tex® sutures provides secure stabilization with excellent anatomical alignment and refractive precision, even after complicated cataract surgery. Sequential haptical fixation allows controlled centration, while the high tensile strenght and resistance to biodegradation of ePTFE may enhance long-term durability compared with traditional polypropylene techniques.