J Korean Ophthalmol Soc.  2011 Nov;52(11):1370-1376.

Transscleral Fixation of Intraocular Lens Using the Triple Cow-Hitch Method

  • 1Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea. ckjoo@catholic.ac.kr


To report the results of scleral suture fixation using a hydrophilic acrylic intraocular lens (IOL) with 3 hollow haptics through a small corneal incision, the Triple Cow-Hitch Method.
Three-point suture fixation of a XL Stabi ZO IOL was performed in 5 eyes of 5 patients with aphakia after penetrating keratoplasty (PKP), vitrectomy and subluxated lens extraction. Postoperatively, the corrected distance visual acuity and spherical equivalent improved in all measured eyes. There were no cases of pigment dispersion or cystoid macular edema (CME).
In this preliminary study, the triple cow-hitch method of suturing a hydrophilic acrylic IOL is an alternative to the conventional 2-point scleral fixation of sutured IOLs.


Aphakia; Intraocular lens; Scleral fixation; Triple cow-hitch method; XL Stabi ZO

MeSH Terms

Keratoplasty, Penetrating
Lenses, Intraocular
Macular Edema
Visual Acuity


  • Figure 1. Anchoring the 10-0 prolene needle to the XL Stabi ZO IOL using the triple cow-hitch scleral fixation method. (A) Illustration of the needle attached to the 10-0 prolene going through the haptic of the XL Stabi ZO IOL from underneath. (B) Illustration of the 10-0 prolene attached to the IOL in the cow-hitch manner. (C) Operation room view of the 10–0 prolene needles attached to all 3 IOL haptics: The Triple cow-hitch method.

  • Figure 2. Illustration of the needle prior to being pulled out of the globe using the Grieshaber forceps.

  • Figure 3. Grabbing and folding the IOL, pushing it through the corneal tunnel into the globe. (A) Illustration of the Stabi IOL folded in half using the IOL forceps and placed into the anterior chamber through the corneal incision site. (B) Operation room view of the Stabi IOL placed into the anterior chamber.

  • Figure 4. Pulling the prolene needle out of the globe. (A) Illustration of grasping the 10–0 prolene needle inside the globe using Grieshaber forceps and pulling it out through the scleral tunnel. (B) Operation room view of the needle parallel to the Grieshaber forceps.

  • Figure 5. Final adjustment of the IOL. (A) Illustration of the IOL prior to being fixed to the scleral wall. (B) Operation room view after centering the IOL.



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