Z-suture: a new knotless technique for transscleral suture fixation of intraocular implants

Abstract

The presented Z-suture is a simple, rapid and safe knotless technique that facilitates transscleral suture fixation of various intraocular implants in the ciliary sulcus like sutured intraocular lenses, artificial iris prostheses, and iris diaphragms. As the knotless approach reliably avoids suture erosion, external fixation can be performed without any protecting scleral flaps or lamellar grooves. The needle is simply passed through the sulcus, and the emerging polypropylene suture is secured in the sclera using a zigzag shaped intrascleral suture (Zsuture). Each pass starts directly adjacent to the exiting site. Five passes are sufficient to reliably fix the suture resisting even maximum tractive forces. Once this procedure is done, the suture can be cut without any knot. By avoiding suture knots, and hence the necessity for intrascleral flaps, this knotless approach may help to reduce suture-related complications such as scleral atrophy, suture erosion and infections.

Long-term results after artificial iris implantation in patients with aniridia

“…It might be helpful to press against the opposite side of the prosthesis with a push-pull hook to facilitate the puncture. After watertight closure of the scleral tunnel incision, the final transscleral fixation of the implant is performed using the Z-suture technique [13]. This may help reduce complications such as scleral necrosis, suture erosion, and infections vitreoretinopathy (PVR)), and one anterior chamber lavage (recurrent haemorrhage of the remnant iris).…”

“…The side-to-side anastomosis for partial prosthesis was performed as previously described by Engels [12]. The final transscleral fixation of the implant was performed using the Z-suture technique [13] or a scleral flap.…”

Half-bow sliding knot: Modified suture technique for scleral fixation using the corneoscleral pocket

“…This is tricky and troublesome, a problem not encountered with the direct scleral fixation technique, in which the knot is applied under direct visualization of the sclera, either under the dissected scleral flap or within a shelved incision. Although a knotless technique has been described, 9 conjunctival peritomy is necessary as the initial step.…”

Choices in Correction of Aphakia during Vitrectomy

“…Szurman et al [8] described a knotless method of IOL fixation in 2010. This employs the friction of the suture passing through the partial thickness of the sclera.…”