I believe the adjustable knot technique described by Dangel is the best method for tying most ophthalmic sutures.1 The main advantages are no slippage, predictable suture tension, and a compact knot that is easy to bury in tissue. I learned this technique almost two decades ago from Douglas Koch, MD during the first week of my fellowship, and since that time I exclusively use it for closing corneal and scleral incisions.
I always place a temporary suture across the incision when I implant a Crystalens IOL to ensure that the chamber does not shallow postoperatively, which could cause the lens to vault anteriorly. The video demonstrates the method for tying this adjustable slide knot after such a case. Rather than the traditional 3-1-1 knot that we all learn during residency training, this technique is a 1-1-1 knot. The first and second throws are in the same direction (during the second throw it is therefore necessary to reach back around the knot to grasp the other end of the suture) so that the resulting knot is able to slide. This is demonstrated in the video when I use the forceps to loosen the knot. I then retighten the knot to the desired tension and the final throw, in the opposite direction, locks the knot. Finally, the video shows that the more compact nature of this knot enables it to be buried easily after trimming the suture ends.
Reference:
- Dangel ME, Keates RH. The adjustable slide knot--an alternate technique. Ophthalmic Surg, 1980; 11:843-6.