Closed-chamber haptic re-externalisation for posteriorly displaced sclerotomy and inadequate haptic tuck in glued posterior chamber intraocular lenses
Reviewed by Sharmina Khan

This technique (online video http://jcrsjournal.org) emphasises the importance of both symmetrical and sufficient anterior placement of sclerotomies to externalise an adequate length of the haptics, which in turn provides good centration and stability of the intra-ocular lens (IOL). The authors describe a secondary procedure to address sclerotomies that haven’t been placed too posteriorly or asymmetric and resulted in IOL tilt. A new sclerotomy is created anterior to the first, avoiding engaging the iris root by turning off the anterior chamber maintainer (AMC) to prevent posterior bowing of the iris. A sharp needle is pointed down through the sclera and into the posterior chamber and then horizontally immediately behind the iris plane in the vitreous cavity. Through a side-port and using micro forceps the haptic is internalised into the eye. The ACM is turned off and a second micro forceps is passed through the anteriorly placed sclerotomy, the haptic grasped and brought out through the anteriorly placed sclerotomy, then tucked into an intra-scleral tunnel. A 26-gauge needle is used to create the intra-scleral tunnel. The advantage of this technique is that it avoids IOL explantation and increases the overall haptic length available for tucking. 

Closed-chamber haptic reexternalization for posteriorly displaced sclerotomy and inadequate haptic tuck in glued posterior chamber intraocular lenses.
Jacob S, Agarwal A, Agarwal A, Narasimhan S.
JOURNAL OF CATARACT AND REFRACTIVE NEWS
2015;41:268-71.