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    Scleral tunnel ‘glued’ fixation technique for slipped IOLs

    Scleral tunnel, “glued” fixation technique works better than alternative fixation techniques in cases where intraocular lenses (IOLs) cannot be placed in capsular bag or in the sulcus, according to Sumit Garg, MD.

    “It’s easier than suture fixation because you don’t have to deal with the spaghetti of the sutures and it will turn out to be more stable long-term,” said Dr. Garg, associate professor of ophthalmology, University of California, Irvine.

    (Figure 1) Externalized haptics. (Images courtesy of Sumit Garg, MD)

    Popularized by Amar Agarwal, FRCOphth, Chennai, India, scleral tunnel fixation avoids the problem of long-term suture degradation, provides good short-term stability through the use of tissue glue, and creates long-term stability through compression of the haptics. 

    Running through the alternatives, Dr. Garg said iris fixation offers the advantages of avoiding scleral or conjunctival surgery, a small, self-sealing incision, and a foldable IOLs with small-incision insertions. But iris fixation requires normal iris anatomy and can chafe the iris, causing pupil ovaling, pseudophakodonesis, and/or increased risk of cystoid macular edema, he added.

    Technique provides separation

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