This video shows Brandon Ayres, MD, handling a complicated IOL exchange with an innovative technique that he pioneered. Dr. Ayres begins by removing a three-piece IOL that was captured in the iris after a vitrectomy and ends with an Akreos one-piece IOL (Bausch + Lomb) secured with a Gore-Tex (W.L. Gore & Associates) suture.
Step by Step
Dr. Ayres first injects triamcinolone acetonide to rule out the presence of vitreous in the anterior chamber. He orients the 23-gauge trocar system 3 mm from the limbus and 2 mm lateral to the central mark (Figure 1). He places the CV-8 Gore-Tex suture via handshake through the main incision and out the trocar. When passing sutures via the sclera, it is key to place the more proximal suture through the trocar/sclera first, which helps decrease the risk of tangles (Figure 2). Once both sides of the lens are laced through the sclera, Dr. Ayres removes the trocars, leaving a nice opening for burying the knot at the end of the case. He recommends slipknots to tighten the sutures to the lens optic in a balanced fashion, side to side to help ensure IOL centration. Dr. Ayres applies just enough tension to center the optic without folding it.
Figure 2. Placing the more proximal suture through the trocar/sclera first helps decrease the risk of tangles.
Eyetube for Innovation
This case is a great example of using Eyetube.net to demonstrate a unique and well-accepted alternative to traditionally sutured IOLs. The Gore-Tex suture will not erode or break over time, and the unique design of the Akreos IOL’s haptics promote a stable optic that is unlikely to tilt, as can occur with traditional PMMA IOLs secured with polypropylene sutures.
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