This young patient sustained severe ocular trauma a few years ago and he had a surgical repair done in another country. He presents to our clinic with very limited vision (light perception).
There is extensive disorganization of the anterior segment with a PMMA IOL on top of the iris and absence of a functional pupil.
The traditional way of using Gore-Tex to sew an IOL to the sclera ends up leaving a band of suture just under the conjunctiva. Even if we make a scleral groove for this suture band, it can still erode through the conjunctiva and lead to problems. Our patient is in his 20s and our suture would ideally last his lifetime.
The technique described by Jamin Brown MD of New York state, uses an intra-scleral pass of the Gore-Tex suture so that it is completely buried and protected.
Next the suture is threaded through the eyelets of the IOL with care taken to keep all suture ends organized. As the saying goes, “keep your spaghetti straight!”
The suture ends are then securely tied and the knot is buried inside the eye. Avoid placing too much tension on the sutures as this can distort the IOL and the sclera. The conjunctiva is then closed and this patient will have a secure IOL for many years to come.
click below to learn how to do an intra-scleral pass of Gore-Tex for IOL fixation: