When the capsule or the small supporting fibers around it can no longer hold an intraocular lens securely, Dr. Tokuhara may reposition the implant and use an additional fixation method. The approach depends on how much natural support remains and the condition of the iris, sclera, cornea, retina, and vitreous.

Potential techniques may include:


• • Sulcus placement with optic capture: When the rim of the anterior capsule remains intact, the lens may be placed in the ciliary sulcus, a supporting space behind the iris. The central optic is then positioned through the capsular opening to improve centration and stability.
  • Yamane sutureless flanged fixation: When capsular support is inadequate, the haptics, or supporting arms, of a three-piece lens are passed through the sclera using a double-needle technique. Small flanges are formed at the haptic tips to hold the lens in place without permanent sutures.
  • Scleral-sutured IOL fixation: The lens may be anchored to the sclera, the white wall of the eye, using Gore-Tex or polypropylene sutures. This can stabilize an existing lens or support another suitable implant when the capsule cannot hold it securely.
  • Iris-sutured fixation: When the iris is healthy enough to provide support, the lens may be centered and secured to the iris using techniques such as McCannel sutures or a Siepser slipknot. These approaches allow the surgeon to tie the supporting sutures through small incisions.
  • Vitrectomy: If vitreous gel has moved forward because of capsule damage, zonular weakness, lens movement, or previous surgery, it may need to be removed from the front of the eye before the lens is secured. This helps clear vitreous from the surgical area and reduce unwanted traction on structures toward the back of the eye.


Not every technique is appropriate for every patient. Dr. Tokuhara evaluates the existing lens, remaining capsular support, prior procedures, and overall eye health before determining whether the implant can be preserved and how it should be stabilized.