Dr. Sergio Canabrava proposes a novel sutureless scleral fixation technique, named four-flanged technique, inspired by Lewis scleral fixation and the Yamane technique, using a 5-0 polypropylene suture, in order to simplify and improve the safety of scleral fixation using single-piece non-foldable IOLs.
A sclerotomy is made transconjunctivally approximately 2 mm from the limbus using a 26-gauge needle. Twenty-three-gauge micro-forceps are used to place a 5-0 polypropylene monofilament into the 26-gauge needle’s lumen through the corneal incision. This needle will guide the monofilament externally. The same maneuver is made 180° from the initial sclerotomy. The corneal suture ends are passed through the IOL eyelets and then heated in order to create a flange, which will create a complex of polypropylene and the two IOL eyelets. The IOL is then placed in the sulcus, pulling the limbus-externalized sutures from both sides. After the correct IOL positioning and centering, the externalized sutures are cut 2 mm from its base and then heated in a flanged fashion, to finally be buried into the scleral tunnel.
Dr. Sergio Canabrava from Brazil has contributed the video to the blog.