Flangeless, flapless, fibrin-glue-less, fully covered, fully tucked (5F) ISHF

ISHF is currently most commonly done using Glued IOL and Yamane techniques.[1-7] A new ISHF technique (5F - Flangeless, Flapless, Fibrin-glue-less, Fully covered, Fully tucked) offers a simplified, safer, faster, and more stable approach.

We present the 5F technique and its advantages over other methods.

Two L-shaped conjunctival peritomies and two 2.5 mm vertical half-thickness scleral grooves 180° apart, perpendicular to limbus, are made. Two partial-thickness scleral pockets are dissected from the grooves, away from the surgeon on the left-hand side and toward the surgeon on the right-hand side. Two 26 G intrascleral Scharioth tunnels are created to the opposite side of groove. After anterior vitrectomy, a three-piece foldable IOL is injected into AC with leading haptic positioned over the iris. Trailing haptic is flexed in using the handshake technique. A bent 26 G/thin-walled 30 G TSK needle passes through inner recess of the scleral pocket in line with the Scharioth tunnel into the eye. Trailing haptic is railroaded into the needle, externalized through the pocket, and temporarily secured with silicone plug followed by similar leading haptic externalization. Final fixation involves retracting haptics up to the scleral groove and tucking them into Scharioth tunnels. Conjunctiva is closed with light cautery.

Highlights of this new technique include enhanced stability from long-length haptic tuck which provides superior horizontal, vertical, and rotational stability; high safety profile due to fully covered haptics, ultra-small microsclerotomies giving ultra-tight fixation, single needle externalization, reduced risks of leak, endophthalmitis, erosion, exposure, flagpole, and rotisserie syndromes; simplified intraoperative IOL centration by adjusting haptic tuck on either side; and elimination of flanges, flaps, fibrin glue and low-temp cautery.

https://youtu.be/JMR4kts9V4k.