Transscleral Fixation of Intraocular Lens Using the Triple Cow-Hitch Method

Jongsoo Joo; You Kyung Lee; Chang Rae Rho; Yong-Soo Byun; Choun-Ki Joo

doi:10.3341/jkos.2011.52.11.1370

Journal List > J Korean Ophthalmol Soc > v.52(11) > 1008935

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Joo, Lee, Rho, Byun, and Joo: Transscleral Fixation of Intraocular Lens Using the Triple Cow-Hitch Method

Original Article

J Korean Ophthalmol Soc 2011;52(11):1370-1376.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.11.1370

Transscleral Fixation of Intraocular Lens Using the Triple Cow-Hitch Method

Jongsoo Joo, MD, You Kyung Lee, MD, Chang Rae Rho, MD, Yong-Soo Byun, MD, Choun-Ki Joo, MD, PhD

Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Choun-Ki Joo, MD, PhD Department of Ophthalmology, Seoul St. Mary's Hospital #505 Banpo-dong, Seocho-gu, Seoul 137-040, Korea Tel: 82-2-2258-1188, Fax: 82-2-2258-1173, E-mail: ckjoo@catholic.ac.kr

Received 22 February 2011 Revised 21 March 2011 Accepted 27 September 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report the results of scleral suture fixation using a hydrophilic acrylic intraocular lens (IOL) with 3 hollow haptics through a small corneal incision, the Triple Cow-Hitch Method.

Case summary

Three-point suture fixation of a XL Stabi ZO IOL was performed in 5 eyes of 5 patients with aphakia after penetrating keratoplasty (PKP), vitrectomy and subluxated lens extraction. Postoperatively, the corrected distance visual acuity and spherical equivalent improved in all measured eyes. There were no cases of pigment dispersion or cystoid macular edema (CME).

Conclusions

In this preliminary study, the triple cow-hitch method of suturing a hydrophilic acrylic IOL is an alternative to the conventional 2-point scleral fixation of sutured IOLs.

Keywords: Aphakia, Intraocular lens, Scleral fixation, Triple cow-hitch method, XL Stabi ZO

References

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Figure 1.

Anchoring the 10-0 prolene needle to the XL Stabi ZO IOL using the triple cow-hitch scleral fixation method. (A) Illustration of the needle attached to the 10-0 prolene going through the haptic of the XL Stabi ZO IOL from underneath. (B) Illustration of the 10-0 prolene attached to the IOL in the cow-hitch manner. (C) Operation room view of the 10–0 prolene needles attached to all 3 IOL haptics: The Triple cow-hitch method.

Figure 2.

Illustration of the needle prior to being pulled out of the globe using the Grieshaber forceps.

Figure 3.

Grabbing and folding the IOL, pushing it through the corneal tunnel into the globe. (A) Illustration of the Stabi IOL folded in half using the IOL forceps and placed into the anterior chamber through the corneal incision site. (B) Operation room view of the Stabi IOL placed into the anterior chamber.

Figure 4.

Pulling the prolene needle out of the globe. (A) Illustration of grasping the 10–0 prolene needle inside the globe using Grieshaber forceps and pulling it out through the scleral tunnel. (B) Operation room view of the needle parallel to the Grieshaber forceps.

Figure 5.

Final adjustment of the IOL. (A) Illustration of the IOL prior to being fixed to the scleral wall. (B) Operation room view after centering the IOL.

Table 1.

Preoperative and postoperative CDVA, SE, and change

Pt	FU (mon)	CDVA			SE (D)
Pt	FU (mon)	Preop (decimal)	Postop (decimal)	LogMAR change	Preop	Postop	Change
1	6	0.4	0.63	−0.2	+4.25	−2.00	6.25
2	6	0.2	0.32	−0.2	+3.50	−0.25	3.75
3	6	0.25	0.32	−0.1	+6.00	+0.37	5.73
4	2	0.2	0.5	−0.4	+11.00	−0.25	11.25
5	2	0.32	0.8	−0.4	−17.13	−2.13	15

CDVA = corrected distance visual acuity; FU = follow-up; NA = not applicable; Pt = patient; SE = spherical equivalent.

Table 2.

Complications and additional procedures

Pt	Complications							Procedures
Pt	Choroidal effusion	Vitreous hemorrhage	Ocular hypertension	Corneal edema	Vitreous prolapse	Decentered IOL	Time to resolution (wk)	Pupil repair	Cortical cleanup
1	No	No	No	Yes	No	No	4.0	Yes	No
2	No	Yes	No	No	No	No	1.0	No	No
3	No	Yes	Yes	No	No	No	1.0	No	No
4	No	No	Yes	No	No	No	4.0	No	No
5	No	No	No	No	No	No	1.0	No	No

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