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24 | EYEWORLD DAILY NEWS | MAY 17, 2020 DAILY NEWS ASCRS VIRTUAL ANNUAL MEETING the Yamane technique) using cautery, making it big enough so that it can't pull through the central eyelet. Place the segment through the incision, then pull it into place with the Prolene suture with some in- strument assistance. Make sure you get the two lateral eyelets of the segment in the bag, and make sure the suture in the central eyelet is over the bag, Dr. Oetting said. Now outside the eye, cut off the suture, get some tension, and use cautery again to make a second flange, tucking it into the groove. View Dr. Oetting's videos detailing these IOL and seg- ment fixation techniques as well as other presentations on managing malpositioned IOLs. Other presentations in IC-1 cover scleral fixation, the Ya- mane technique, and more. Editors' note: Dr. Oetting has no financial interests related to his presentation. technique for sutureless ring or segment fixation. "It's very similar to a rivet in my opinion," Dr. Oetting said. He showed a case video of a dislocated lens from trau- ma. First, use a 300-µm blade to make a partial-thickness groove into the eye. Going forward with the phaco portion of the procedure, Dr. Oetting centered the rhexis on the lens, not the pupil. He placed tem- porary MST capsule retractors, using cohesive viscodissec- tion, then proceeded with phaco. He inserted the CTR with assistance from a Sinskey hook. Using 5.0 Prolene, he went through the groove he created. Go anterior through the capsule tension ring and "come out wherever we can," he said. After cutting off the needle, pull the suture through the eye. Going through the capsule tension segment at this point outside the eye, Dr. Oetting showed how he made flanges in the suture (similar to around the forceps is the side that's going to the iris. Dr. Oet- ting said he usually goes 3-2-1 or 3-1-1 with these knots. The "moment of truth" is when you push the optic posterior. "It's a great technique when you've got a lot of cap- sule left. It's very simple and doesn't require a lot of incision into the eye," he said. As a bonus, Dr. Oetting also covered suturing a capsular tension segment. He said there are a number of techniques to do this, but he focused first on using a similar sliding knot technique. He showed how to use double-armed 9.0 Prolene through the sclera, going under the iris and out through the cornea on both sides with the Prolene. Next pull the free end out through an incision (it needs to be large enough for the segment), passing it through the central eyelet of the capsular tension segment outside the eye. Place the tension segment in the eye with the two lateral haptics in the bag; pull a little bit on the suture to get it snug. "But now you've got some work to do with the sliding knot," he said, showing how you reach across the eye, grab the suture, and pull the loop out so that you have a loop and a free end through the same incision. Wrap around the side of the loop, which is going to the sclera, Dr. Oetting explained. Grab the free end, pull on both sides, and draw that knot into the eye. After discussing the details of the technique, Dr. Oetting shared another case video. He also presented the Canabrava double-flanged by Liz Hillman Editorial Co-Director I OL exchange and surgical management of malposi- tioned and malfunctioning IOLs was the topic of a Sat- urday instruction course. One presentation by Thom- as Oetting, MD, Iowa City, Iowa, took a look at using a sliding knot for IOL fixation. "The suturing of the intraocular lens to the iris is a classic technique, and it's still very useful typically when there is a lot of capsule left in the eye," Dr. Oetting said. Dr. Oetting described the McCannel technique, which he said is the classic one where you bring the suture out through a single paracentesis, tie the knot externally, then draw the iris out of the para- centesis to tie it down. "It's hard to get that as tight," he said. This led him to the Chang Siepser sliding knot technique. Dr. Oetting showed a video of this technique on a patient who had a decentered multifo- cal IOL. You capture the optic by the pupil, he said, placing a long, curved CTC-6L needle through the cornea, under the iris, under the haptic, then back out again. Draw out both the free end and the loop, wrap around the loop three times, grab that loop, and draw that knot down, Dr. Oetting said. Dr. Oetting said he places these knots at 3 and 9 o'clock "so that the pupil doesn't look as much like a cat." In his case video, Dr. Oetting explained that whenever you do a sliding knot you always have a loop and a free end through the same paracentesis. He noted that it's important to make sure the side you're wrapping Instruction on managing, fixating malpositioned and malfunctioning IOLs Dr. Oetting shows a case video of his use of a sliding knot for IOL fixation. Source: Thomas Oetting, MD, screenshot from presentation

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