Z-suture: a new knotless technique for transscleral suture fixation of intraocular implants

TLDR

The Z‑suture is a simple, rapid, knotless method that enables transscleral fixation of intraocular implants in the ciliary sulcus without suture erosion or the need for scleral flaps. The technique involves passing a needle through the sulcus and securing the polypropylene suture in the sclera with a zig‑zag intrascleral pattern, starting each pass adjacent to the exit site and requiring only five passes before the suture can be cut without a knot. Five passes provide a secure fixation that withstands maximum tractive forces, and the knotless design may reduce complications such as scleral atrophy, erosion, and infection.

Abstract

The presented Z-suture is a simple, rapid and safe knotless technique that facilitates transscleral suture fixation of various intraocular implants in the ciliary sulcus, such as sutured intraocular lenses, artificial iris prostheses and iris diaphragms. As the knotless approach reliably avoids suture erosion, external fixation can be performed without any protecting scleral flaps or lamellar grooves. The needle is simply passed through the sulcus and the emerging polypropylene suture is secured in the sclera using a zigzag-shaped intrascleral suture (Z-suture). Each pass starts directly adjacent to the exiting site. Five passes are sufficient to reliably fix the suture so that it resists even maximum tractive forces. Once this procedure is done, the suture can be cut without any knot. By avoiding suture knots, and hence the need for intrascleral flaps, this knotless approach may help to reduce suture-related complications such as scleral atrophy, suture erosion and infections.