Saloon Door Technique – “open sky” IOL exchange utilising flanged haptic fixation behind a pre-existing Artificial Iris

Purpose

This paper introduces a novel surgical approach, the “Saloon Door Technique”, which allows intraocular lens (IOL) replacement behind a pre-existing Artificial Iris (AI) without its removal.

Observations

A 57-year-old patient with a history of complicated cataract surgery, AI implantation, and recurrent corneal decompensation presented with a dislocated anterior chamber IOL. To prevent further corneal decompensation, we performed an IOL exchange and penetrating keratoplasty under open-sky conditions while preserving the AI. The AI was radially incised at two opposite sites to allow the insertion of a new 3-piece IOL through the ‘saloon door’ into the posterior chamber. The haptics were then externalized and flanged with a Forceps Needle using a modified Yamane technique. The postoperative course was uneventful, with stable IOL positioning and a clear corneal graft at follow-up.

Conclusions and importance

The Saloon Door Technique enables IOL implantation behind a pre-existing AI while preserving its integrity. By making two controlled incisions in the AI, the IOL can be carefully maneuvered through the “saloon door”, followed by scleral fixation using a modified Yamane technique. This technique represents a valuable advancement in anterior segment surgery for complex cases involving AI and IOL exchange.