Scleral tunnel fixation is easiest done with an assistant and it requires coaxial micro instruments, including a micro forceps for the anterior segment, an anterior chamber maintainer, and fibrin glue.
The procedure will not work with every IOL, Dr. Garg added. “You want something with a relatively resistant haptic, something that can be bent and maintains its shape,” he said.
He recommended the Aaren EC-3 PAL (acrylic optic, polyvinylidene fluoride haptic) IOL (Zeiss Meditec).
Dr. Garg advised making sure the haptics are 180º apart. Grab the haptic during insertion and try not to lose it once it’s externalized. The sclerostomy should only be about 23-gauge, he said. Dr. Garg uses a scleral scale ruler.
In the case of a large, white-to-white measurement, he recommended orienting the haptics vertically.
“Even though this is called a ‘glued’ IOL, it’s not really glued long-term,” Dr. Garg explained. “The glue is meant for initial fixation and healing. The fixation is because of the haptic in the scleral tunnel. The glue will dissolve over the first week to two. You could do it without glue if you have to. I use a vicryl suture to fixate the haptic just to provide short-term fixation while the haptic secures itself long-term.”