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Combined penetrating keratoplasty with extraocular needle-guided haptic insertion technique

Scleral fixation of intraocular lens (SFIOL) is a challenge in eyes with opaque corneas. It is preferable to implant the IOL before performing penetrating keratoplasty. Most techniques described so far involve SFIOL following corneal trephination (open sky) which increases the risk of expulsive choroidal hemorrhage. Extraocular needle-guided haptic insertion technique involves extraocular docking of the IOL haptic into a bent 26-gauge needle followed by its exteriorization. Since this crucial step of SFIOL surgery is completely extraocular, this method can be used to safely place an SFIOL in a well-formed globe even before corneal trephination. Use of a silicone stopper over the leading haptic prevents intraocular rebound of the haptic.