Spatula scaffold: An iris-sparing technique for lensectomy

Abstract

Lensectomy with vitrectomy is often performed for crystalline lenticular subluxation. We report a new technique and a practical approach that involves the placement of a spatula beneath the iris tissue that facilitates retroiridial removal of subluxated lens and acts as a scaffold by protecting the iris tissue from being accidentally trapped into the vitrectomy cutter port. Our technique facilitates management of the lens and vitreous without any trauma to the iris and secondarily obviates the need to perform an iris repair procedure that may arise due to iatrogenic reasons.

Figure 1

Iris tissue entrapped and accidentally cut with the vitrectomy cutter probe while performing lensectomy

Figure 2

Spatula scaffold for lensectomy. (a) Two partial-thickness scleral flaps made as in a glued intraocular lens surgery and fluid infusion is introduced. (b) Lensectomy is performed and iris spatula is introduced. (c) Iris spatula guides the path of lensectomy. (d) Lensectomy with vitrectomy is complete

Figure 3

Spatula scaffold in glued intraocular lens scaffold. (a) Glued intraocular lens scaffold technique is performed and peripheral residual cortex is observed. (b) The iris spatula is placed beneath the iris before the vitrectomy is begun. (c) The spatula acts as a guide for the movement of the vitrectomy probe. (d) Peripheral cortical matter removed