Luxated intraocular lens fixation using intravitreal cow hitch (girth) knot

Abstract

Objective To describe a technique for suturing a luxated intraocular lens (IOL) in the vitreous cavity to the ciliary sulcus using intraocular cow hitch (girth) knots without IOL extraction. Design Noncomparative interventional case series. Participants Five patients with a luxated IOL in the vitreous cavity. Intervention All patients underwent surgery to fixate the IOL using this technique. Methods A three-port vitrectomy was performed in all five cases. A needle with looped 10-0 polypropylene was introduced into the vitreous cavity through a sclerotomy incision, and only the needle was passed out of the eye, guided by a bent 27-gauge needle from the 3-o’clock position 1.5 mm from the limbus. A cow hitch (girth) knot at the end of the loop was made outside the globe, grasped with a straight intravitreal forceps, and introduced into the vitreous cavity. Hooking the cow hitch (girth) knot around the haptics of the IOL in the vitreous cavity, the 10-0 polypropylene was pulled so that the IOL haptic was fixated onto the sulcus. After the opposite haptic was brought into the anterior chamber, the 10-0 polypropylene was looped around the haptics of the IOL and manipulated with a push-and-pull hook in the anterior chamber through the two corneal side ports to make a cow hitch (girth) knot outside the anterior chamber. By pulling up the suture, the knot was brought back and tied in the anterior chamber. It was then fixated to the ciliary sulcus at the 9-o’clock position. Main outcome measures Patients were evaluated for visual acuity, refraction, and surgical complications associated with the procedure. Results In all five cases, the IOL fixated stably and remained well positioned. No significant intraoperative or postoperative complications occurred. Conclusions This technique enables secure fixation of the luxated IOL in the vitreous without extracting it.