Scleral suture fixation is one of several techniques used for secondary lens implantation in cases of inadequate capsular support for which many variations have been published. A transscleral suture can be accomplished using either an external or internal approach. The lens can be implanted using an injector with large incisions for unfolding lenses or also via small self-sealing incisions. Episcleral fixation of the suture can be accomplished by protecting the knot under scleral flaps, intrascleral rotation of the knot and using sclerocorneal pockets or scleral grooves. The intrascleral Z-suture with five intrascleral passes of the suture is a knotless technique providing several advantages.
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