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On Capsule Membrane Fixation

On Capsule Membrane Fixation We read with interest the article by Gimbel et al1 on capsule membrane suture fixation of decentered sulcus intraocular lenses in cases of absence of in-bag fixation. Gimbel and colleagues suggest suturing the haptics of the intraocular lens to fibrotic capsular remnants by piercing the capsule directly with a needle attached to a Prolene suture. Even though it was not referenced, we previously described a similar technique for suturing intraocular lens haptics to nonfibrotic anterior capsules.2 Fibrotic capsular remnants can withstand the forces of the Prolene; however, a naive capsule is very fragile and tears very easily with the Prolene suture. In our technique, microcapsulorrhexis is performed once or twice on the anterior capsule so that the needle can go through the capsule without piercing the capsular remnants directly. This allows the Prolene to be moved within the microcapsulorrhexis without the danger of tearing the capsule. Thus, the knot can be tied firmly against the haptic. The microcapsulorrhexis ensures that the only part of the Prolene that is in contact with the capsule is underneath the haptic, thus making it safer to tie knots while avoiding tearing the capsule with tangential tractions. With this technique, it is possible to expand capsular sutures to nonfibrotic capsules. Our technique can even be used directly during the original complicated cataract surgery case on the naive anterior capsule, even before fibrosis occurs, greatly increasing the number of cases in which capsular sutures can be performed. Back to top Article Information Correspondence: Dr Falcão, Department of Ophthalmology, Hospital de São João, Faculdade de Medicina, Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal (falcao@med.up.pt). Conflict of Interest Disclosures: None reported. References 1. Gimbel HV, Camoriano GD, Shah CR, Dardzhikova AA. Capsule membrane suture fixation of decentered sulcus intraocular lenses. Arch Ophthalmol. 2012;130(1):101-10522232477PubMedGoogle ScholarCrossref 2. Domingues M, Falcão M, Fernandes V, Falcão-Reis F. Anterior capsule haptic fixation: a new technique for recentring subluxated IOLs. Acta Ophthalmol. 2012;90(7):690-69221726423PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Ophthalmology American Medical Association

On Capsule Membrane Fixation

Abstract

We read with interest the article by Gimbel et al1 on capsule membrane suture fixation of decentered sulcus intraocular lenses in cases of absence of in-bag fixation. Gimbel and colleagues suggest suturing the haptics of the intraocular lens to fibrotic capsular remnants by piercing the capsule directly with a needle attached to a Prolene suture. Even though it was not referenced, we previously described a similar technique for suturing intraocular lens haptics to nonfibrotic anterior...
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Publisher
American Medical Association
Copyright
Copyright © 2013 American Medical Association. All Rights Reserved.
ISSN
2168-6165
eISSN
2168-6173
DOI
10.1001/jamaophthalmol.2013.1484
Publisher site
See Article on Publisher Site

Abstract

We read with interest the article by Gimbel et al1 on capsule membrane suture fixation of decentered sulcus intraocular lenses in cases of absence of in-bag fixation. Gimbel and colleagues suggest suturing the haptics of the intraocular lens to fibrotic capsular remnants by piercing the capsule directly with a needle attached to a Prolene suture. Even though it was not referenced, we previously described a similar technique for suturing intraocular lens haptics to nonfibrotic anterior capsules.2 Fibrotic capsular remnants can withstand the forces of the Prolene; however, a naive capsule is very fragile and tears very easily with the Prolene suture. In our technique, microcapsulorrhexis is performed once or twice on the anterior capsule so that the needle can go through the capsule without piercing the capsular remnants directly. This allows the Prolene to be moved within the microcapsulorrhexis without the danger of tearing the capsule. Thus, the knot can be tied firmly against the haptic. The microcapsulorrhexis ensures that the only part of the Prolene that is in contact with the capsule is underneath the haptic, thus making it safer to tie knots while avoiding tearing the capsule with tangential tractions. With this technique, it is possible to expand capsular sutures to nonfibrotic capsules. Our technique can even be used directly during the original complicated cataract surgery case on the naive anterior capsule, even before fibrosis occurs, greatly increasing the number of cases in which capsular sutures can be performed. Back to top Article Information Correspondence: Dr Falcão, Department of Ophthalmology, Hospital de São João, Faculdade de Medicina, Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal (falcao@med.up.pt). Conflict of Interest Disclosures: None reported. References 1. Gimbel HV, Camoriano GD, Shah CR, Dardzhikova AA. Capsule membrane suture fixation of decentered sulcus intraocular lenses. Arch Ophthalmol. 2012;130(1):101-10522232477PubMedGoogle ScholarCrossref 2. Domingues M, Falcão M, Fernandes V, Falcão-Reis F. Anterior capsule haptic fixation: a new technique for recentring subluxated IOLs. Acta Ophthalmol. 2012;90(7):690-69221726423PubMedGoogle ScholarCrossref

Journal

JAMA OphthalmologyAmerican Medical Association

Published: Jun 1, 2013

References

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