There are so many innovative techniques in ophthalmology, that it is quite a challenge to learn all of them. This video shows our guest surgeon using a Z-suture technique to secure a three-piece IOL using 10-0 Prolene. It is a technique that I have not used so I was interested in learning more.
Our guest surgeon explains that this technique was first described by Prof. Szurman in 2010 https://pubmed.ncbi.nlm.nih.gov/20139289/
We use a 10-0 prolene suture with a straight needle on each end. It is then passed at about 1.5mm posterior to the limbus and pulled out with a cannula behind the iris 180 degrees away. The inside part is then grabbed with a push/pull instrument and pulled out through the tunnel (2.65mm). The suture is then cut so you have one ending that goes to the nasal part and one that goes to the temporal part of the sclera. Then the first haptic of the three-piece IOL is knotted (3-1-1) with the suture that goes to the nasal part. The IOL is then implanted leaving one haptic outside and then the other haptic is knotted with the suture that goes to the temporal part. The IOL is then positioned in the sulcus and the outside part of the sutures are fixated intrasclerally with the straight needle. By creating at least five 180 degree turns there is enough hold so the suture can be cut without a knot. This technique can also be used for iris implants, sclera-fixated capsular tension rings and also for re-fixation of a dislocated three-piece IOL inside the eye. One disadvantage is the longer duration of the procedure.
While most surgeons would now use a Yamane technique or perhaps a belt-loop procedure, it is useful to have more tools (and techniques) in your surgical toolbox.
