Appropriate positioning of the surgeon and the patient’s eye is essential, and the goal in selecting and adjusting a particular surgical position is to maintain the ease of surgery while allowing proper and adequate access to the surgical site.
The handshake technique is an essential prerequisite for performing glued IOL surgery, and its applicability and importance cannot be undermined by any measures. This technique essentially comprises the transfer of haptics from one hand to another until the tips of the haptics are grasped and externalized from the respective sclerotomy sites. Knowledge of this technique is also essential to manage malpositioned IOLs and the slippage of haptics from the sclerotomy sites, where it comes as a rescue measure to aid the surgeon. Another important nuance of this technique is the movement of the surgeon’s hand, which follows the direction of the curvature of the haptics that are being manipulated. Doing so eliminates the possibility of breakage of the haptics due to inadvertent pull in the wrong direction. The main consideration in doing so is the appropriate positioning of the surgeon while performing the surgery (Figures 1a and 1b).
In glued IOL surgery, two partial-thickness scleral flaps are made 180° opposite to each other, and the sclerotomy is positioned beneath these flaps. With the flaps made at the 3 and 9 o’clock positions, the appropriate positioning of the surgeon will be at 12 o’clock, and with flaps made at 6 and 12 o’clock, it will be with the surgeon seated on the temporal side (Figures 2a to 2f). In short, the surgeon should be seated perpendicular to the axis of the flaps so that the direction of the movement of the handshake technique will be along the axis of the two scleral flaps. The plane of the scleral flaps and the plane of performing a handshake should be nearly perpendicular to the surgeon’s position, and it should not be aligned in the same direction.
Adopting this simple yet important measure reduces intraoperative manipulation and indirectly improves the outcome of the surgery.
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- Amar Agarwal, MS, FRCS, FRCOphth, is director of Dr. Agarwal’s Eye Hospital and Eye Research Centre. Agarwal is the author of several books published by SLACK Incorporated, publisher of Ocular Surgery News, including Phaco Nightmares: Conquering Cataract Catastrophes, Bimanual Phaco: Mastering the Phakonit/MICS Technique, Dry Eye: A Practical Guide to Ocular Surface Disorders and Stem Cell Surgery and Presbyopia: A Surgical Textbook. He can be reached at 19 Cathedral Road, Chennai 600 086, India; email: firstname.lastname@example.org; website: www.dragarwal.com.
- Priya Narang, MS, is the director of Narang Eye Care & Laser Centre, Ahmedabad, India. She can be reached at email: email@example.com.
Disclosures: The authors report no relevant financial disclosures.