Use of a Mirror Needle Holder With Transsclerally Sutured Posterior Chamber Intraocular Lenses

A mirror needle holder has been designed to facilitate the passage of a needle through the ciliary sulcus during transscleral fixation of posterior chamber (PC) intraocular lens (IOLs). Two human post-mortem eyes were used to demonstrate the efficacy of this mirror used as the needle holder. This method was compared with the current method of passing sutures without view of the ciliary sulcus. The mirror needle holder demonstrated precise passage of the needle into the ciliary sulcus by direct visualization of the ciliary processes and sulcus. This method may avoid the complications associated with transsclerally sutured PC IOLs during penetrating keratoplasty and secondary IOL placement. [Ophthalmic Surg Lasers 1996;27:720-724.] During penetrating keratoplasty with a secondary intraocular lens (IOL) implantation, transscleral fixation of a posterior chamber (PC) IOL offers an excellent means of visual rehabilitation in the absence of a supportive capsular bag. However, the standard technique of transsclerally sutured PC IOLs is performed without view of the loop placement into the ciliary sulcus. The best documentation for the location of the ciliary sulcus has been reported' but provides no direct view of the needle passage underneath the iris. Although complications of a poorly sutured PC IOL are rare, they can threaten vision. 2-4 We have described the uses of an anterior segment mirror 5 during penetrating keratoplasty and anterior segment reconstruction. This mirror has been modified as a needle holder to aid in direct view of the placement of the needle for the transsclerally sutured PC IOL. We compare this new method with the standard method.