Gore-Tex suture can be used in small-incision scleral fixation of hydrophilic acrylic IOL

Secondary IOL placement is often associated with an IOL exchange due to previous IOL subluxation or dislocation and, less commonly, aphakic correction. The location of IOL placement is within the anterior chamber or posterior chamber. Techniques include anterior chamber angle haptic placement, iris fixation, ciliary sulcus placement with or without scleral suture fixation based on capsular support status, or IOL haptic externalization with haptic tucking in the scleral pocket or, rarely, within an intact capsular bag.While anterior chamber placement is straightforward, posterior chamber placement involves a choice of sutures and wound size, depending on whether a foldable or non-foldable IOL is chosen. Additionally, both the path of the IOL and the final resting position of the IOL should be free of vitreous for an optimal result and a smooth surgical completion of the procedure. While a large incision wound with a non-foldable IOL works well and is time tested, the move toward providing optimal vision for our patients involves a smaller incision with less iatrogenic induction of corneal astigmatism combined with a foldable IOL. There is a trend toward moving from Prolene sutures to Gore-Tex sutures for scleral-fixated IOLs, due to potential suture longevity and IOL stability over time.