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Prolene Beltloop

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Title:  Prolene Beltloop
Author:  Cole Joseph Swiston; Craig Chaya
Date:  07/11/2024

IOL reposition using a Beltloop Technique

History: 78 y/o patient with a history of pseudoexfoliation syndrome presented with inferior subluxation of the IOL/bag complex with the superior margin of capsule just above the visual axis in the pupil. The best corrected vision was 20/25 and IOP was normal but the IOL was also tilted with iris contact. The decision was made to reposition and stabilize the IOL using scleral fixation.

The prolene beltloop technique has been popularized by Dr. Canabrava and Dr. McCabe and this video demonstrates our variation of this IOL fixation method.

  1. The visual axis is marked
  2. Marks are made at the limbus, 180 degrees apart, in the area of the optic/haptic junction.
  3. Several paracentesis incisions are made for access to the anterior chamber.
  4. Lidocaine with epinephrine is injected, followed by viscoelastic solution to stabilize the anterior chamber.
  5. Calipers are used to mark 3.5mm posterior to the posterior edge of the limbal blue zone.
  6. A bent 30-gauge TSK needle (commonly used in the Yamane technique) is used to enter the sclera perpendicular to the ocular surface, entering posterior to the iris plane.
  7. A Bechert nucleus rotator (tip shaped like a “Y”) is used to stabilize the IOL as the needle pierces the optic at the optic-haptic junction.
  8. 6-0 Prolene suture is threaded through the opposite paracentesis and is docked into the needle with a Micrograsper.
  9. The needle/suture is externalized using a Malyugin manipulator to provide counter traction as the needle is pulled through the IOL.
    1. At this point the Prolene can be flanged by melting the leading end of the suture with low-temperature handheld cautery to ensure it is not accidently pulled back into the eye.
  10. This process is repeated with a mark 2 mm from the limbus (radial, in the same axis as the first mark) to complete the beltloop
    1. Viscoelastic can be used to expand the sulcus space to ensure that the needle enters anterior to the IOL/bag complex.
  11. Steps 3-8 are repeated for the other optic-haptic junction.
  12. After one flange is created with low temp cautery on either side, tiers can be used to pull the tail ends of Prolene back and forth to ensure good IOL centration.
  13. The remaining suture is trimmed and flanged – adequate tension is critical at this step for IOL centration and to avoid tilt.
    1. For the first side, pull on the suture slightly more than is needed to “overcorrect” and decenter the IOL so that the flanged end seats well into the sclerotomy with tension from the opposite side. The bulbed ends of the suture should sit flush with scleral surface, with the IOL well-centered.
    2. For the second side, again, pull on the suture slightly more than is needed and flange at a length where the suture “snaps back” into the sclera and the IOL becomes centered as the suture end is released. Trim and re-melt the suture as needed until good centration is achieved.
  14. Ensure all flanges are buried and gently “wiggle” the overlying conjunctiva over each flanged suture end to ensure that it is well-covered.
  15. In this case, an anterior vitrectomy was performed through a single pars plana port (posterior approach).
  16. Create a small nasal peripheral iridectomy with the anterior vitrector.
  17. Remove the port and suture the sclerotomy with 6-0 gut or 7-0 Vicryl suture
  18. Inject 0.1cc of intracameral preservative-free Moxifloxacin.
  19. Hydrate all wounds and ensure they are sealed.

Faculty Reviewer: Susan Chortkoff, MD
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