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June 2013

On Capsule Membrane Fixation

Author Affiliations

Author Affiliations: Department of Ophthalmology, Hospital de São João and Faculty of Medicine, University of Porto, Porto (Dr Falcão), and Clipóvoa Clinica, Póvoa de Varzim, and Department of Ophthalmology, Hospital de Braga, Braga (Dr Domingues), Portugal.

JAMA Ophthalmol. 2013;131(6):821. doi:10.1001/jamaophthalmol.2013.1484

We read with interest the article by Gimbel et al1 on capsule membrane suture fixation of decentered sulcus intraocular lenses in cases of absence of in-bag fixation. Gimbel and colleagues suggest suturing the haptics of the intraocular lens to fibrotic capsular remnants by piercing the capsule directly with a needle attached to a Prolene suture. Even though it was not referenced, we previously described a similar technique for suturing intraocular lens haptics to nonfibrotic anterior capsules.2 Fibrotic capsular remnants can withstand the forces of the Prolene; however, a naive capsule is very fragile and tears very easily with the Prolene suture. In our technique, microcapsulorrhexis is performed once or twice on the anterior capsule so that the needle can go through the capsule without piercing the capsular remnants directly. This allows the Prolene to be moved within the microcapsulorrhexis without the danger of tearing the capsule. Thus, the knot can be tied firmly against the haptic. The microcapsulorrhexis ensures that the only part of the Prolene that is in contact with the capsule is underneath the haptic, thus making it safer to tie knots while avoiding tearing the capsule with tangential tractions. With this technique, it is possible to expand capsular sutures to nonfibrotic capsules. Our technique can even be used directly during the original complicated cataract surgery case on the naive anterior capsule, even before fibrosis occurs, greatly increasing the number of cases in which capsular sutures can be performed.

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