Bimanual Folding Technique - A Method to Implant Phakic Refractive Lenses (PRL) in Eyes without maximal Mydriasis
Augenklinik im Dietrich-Bonhoeffer-Klinikum, Neubrandenburg
Purpose: In eyes with maximal mydriasis, implantation of the PRL is not difficult, because the PRL can easily be pushed behind the iris with a spatula or viscosurgically. In eyes without maximal pupil mydriasis, usually the iris is in contact with the anterior lens surface. It can be difficult to move the PRL from the anterior chamber behind the iris. In this situation, the bimanual folding technique is a useful method.
Method: After making one 3-mm clear cornea incision (3 mm) in the steep corneal meridian and two 1-mm incisions (each 90 ° apart from the first), the anterior chamber is filled with viscoelastic. The PRL is implanted into the anterior chamber via Dementevs folding forceps or via an injector. After repeated viscoelastic instillation in front of and behind the PRL, a smooth iris spatula is pushed under the IOL via one incision and a Neuhann spatula via the second incision. The lower spatula works as a heaver, that helps to fold the PRL backwards with the Neuhann spatula. That leads to an angle of 40 to 50 ° between the anterior PRL haptic and the anterior lens surface. Due to this angle, the PRL haptic can glide behind the iris also in eyes with only moderate pupil dilatation. If only one egde of the haptic is successfully located behind the iris, also the second egde can be moved behind the iris by rotation of the PRL with both instruments. Hereafter, the posterior haptic can
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