To the Editor.
—Kaplan et al1 noted that postoperative ptosis could be significantly reduced by avoidance of trauma to the superior rectus muscle complex. Because of this, I have been performing extracapsular cataract surgery with posterior chamber lens implantation without the use of a superior rectus bridle suture. Cataract removal can be performed without this suture. However, standard insertion (ie, 12-o'clock position) of a posterior chamber lens is difficult without a superior rectus bridle suture.For the past year, I have been inserting posterior chamber lenses between the 9- and 12-o'clock positions on the globe (I am right-handed). My technique is as follows:After expression of the nucleus and an anterior capsulectomy, three 8-0 polyglactin (Vicryl) sutures are placed at the 10:30, 12-o'clock, and 1:30 positions. Aspiration-irrigation is performed in the spaces between the 9-o'clock and 10:30 positions and between the 1:30 and 3-o'clock positions. Immediately before lens insertion,
Bullock JD. Prevention of Post-Cataract Extraction Ptosis. Arch Ophthalmol. 1986;104(7):972. doi:10.1001/archopht.1986.01050190030008