Glued endocapsular hemi-ring segment for fibrin glue–assisted sutureless transscleral fixation of the capsular bag in subluxated cataracts and intraocular lenses

A partial thickness scleral flap is made in the quadrant of subluxation. Anterior vitrectomy is done if required. Capsulorhexis, hydrodissection, and hydrodelineation are performed gently. A cohesive OVD is injected under the iris in the zone of dialysis to create space and to push the iris upward. A sclerotomy is made under the scleral flap with a 20-gauge needle, taking care that the needle emerges in the space between the iris and the anterior lens capsule. The haptic of the glued endocapsular hemi-ring segment is exteriorized through the sclerotomy using an end gripping microforceps introduced through the sclerotomy. At the same time, the rest of the ring segment is flexed into the anterior chamber by holding it at the scrolls and fish-tailing it in a 1-handed technique. The 2 arms of the ring segment are inserted under the capsulorhexis and the circular scrolls are made to engage the capsulorhexis margin. Pulling on the exteriorized haptic pulls the entire capsular bag complex and centers it. The haptic is then cut to the desired length and tucked into a scleral tunnel made at the edge of the scleral flap with a 26-gauge needle, curving toward the limbus. Phacoemulsification is then carried on as usual followed by epinucleus and cortex aspiration and IOL implantation. Centration is further adjusted if desired by adjusting the degree of haptic tuck into the scleral tunnel. The scleral flap is then closed with fibrin glue. The conjunctiva is also closed with fibrin glue.