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Z-suture: a new knotless technique for transscleral suture fixation of intraocular implants
  1. P Szurman,
  2. K Petermeier,
  3. S Aisenbrey,
  4. M S Spitzer,
  5. G B Jaissle
  1. University Eye Hospital, Center of Ophthalmology, Eberhard-Karls University, Tuebingen, Germany
  1. Correspondence to Dr G B Jaissle, University Eye Hospital, Centre of Ophthalmology, Eberhard-Karls University, Schleichstr. 12, 72076 Tübingen, Germany; G.Jaissle{at}


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.

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  • Presented at the 24th Congress of the European Society of Cataract and Refractive Surgery (ESCRS), London, UK, 11 September 2006 and at the Annual Congress of the American Society of Cataract and Refractive Surgery (ASCRS), San Diego, California, USA, 29 April 2007.

  • Competing interests None declared.

  • Ethics approval Obtained.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.