Suspension of the globe during intraocular surgery.

The unopened eye maintains a relatively stable spherical contour due to the expansile influence of the intraocular pressure. When the eye is opened this expansile pressure is lost and some degree of collapse of the scleral shell ensues. In eyes with a relatively flaccid sclera an anterior segment incision may induce significant reduction in the volume of the posterior segment of the globe. During intracapsular cataract extraction on such eyes, scleral collapse can cause anterior displacement of the lens and iris when the eye is opened and vitreous loss as soon as the lens is extracted. Scleral collapse tends to occur during intraocular surgery on previously aphakic eyes. In this situation it may become difficult to achieve a vitreous-free anterior sement by open sky vitrectomy. Metallic scleral supporters prevent inward collapse of that portion of the sclera to which they are attached. They do not prevent downward collapse of the posterior sclera shell. Upward traction is required to prevent the downward component of scleral collapse. A system for controlled suspension of the globe during intraocular surgery has been devised and used in a variety of surgical procedures. The apparatus is simple and it does help to minimize downward scleral collapse. It does not prevent scleral identation or distortion by external forces and cannot substitute for inadequate anesthesia and akinesia or faulty surgical technique.