Complications ConsultFrom OSN APAO

Correct positioning essential for handshake technique

This simple measure reduces intraoperative manipulation and indirectly improves surgical outcomes.

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).

Figure 1. Surgeon positioning. Two partial-thickness scleral flaps made 180° opposite to each other, and the surgeon sits perpendicular to the direction of the axis of the flap (a). The red cross denotes wrong positioning, and the green sign denotes correct surgeon positioning (b).

Images: Narang P, Agarwal A

Correct technique

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.

Figure 2. Clinical demonstration. Phacoemulsification being performed with the surgeon seated superiorly (a). Two partial-thickness scleral flaps made at 6 and 9 o’clock positions (b). The surgeon changes the seating position to temporal side and starts performing glued IOL surgery. A three-piece foldable IOL is loaded and injected inside the eye (c). Leading haptic is externalized, and the trailing haptic is flexed into the eye for the handshake maneuver (d). Handshake being performed (e). Both haptics smoothly externalized (f).

Adopting this simple yet important measure reduces intraoperative manipulation and indirectly improves the outcome of the surgery.

Disclosures: The authors report no relevant financial disclosures.

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).

Figure 1. Surgeon positioning. Two partial-thickness scleral flaps made 180° opposite to each other, and the surgeon sits perpendicular to the direction of the axis of the flap (a). The red cross denotes wrong positioning, and the green sign denotes correct surgeon positioning (b).

Images: Narang P, Agarwal A

Correct technique

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.

Figure 2. Clinical demonstration. Phacoemulsification being performed with the surgeon seated superiorly (a). Two partial-thickness scleral flaps made at 6 and 9 o’clock positions (b). The surgeon changes the seating position to temporal side and starts performing glued IOL surgery. A three-piece foldable IOL is loaded and injected inside the eye (c). Leading haptic is externalized, and the trailing haptic is flexed into the eye for the handshake maneuver (d). Handshake being performed (e). Both haptics smoothly externalized (f).

Adopting this simple yet important measure reduces intraoperative manipulation and indirectly improves the outcome of the surgery.

Disclosures: The authors report no relevant financial disclosures.