Fig. 6. Technique for the ab interno approach. A. First the long needles are passed under the iris, aiming for the inferior ciliary sulcus. Two needle passes are made for each haptic if four-point fixation is desired. Needles exit under previously dissected scleral flaps. B. A second pair of short needle passes is made under the superior iris for the suture to be tied to the second haptic. C. Girth hitch can be used to attach the polypropylene suture loop to the intraocular lens (IOL) haptic. This technique is more rapid than tying the suture to the haptic. Alternately, the suture can be attached to the IOL haptics before the transscleral needle passes, but the surgeon must avoid tangling the long sutures. D. After exiting the eye under the previously dissected scleral flaps, the sutures are tied securing the IOL into position. Appropriate suture tension is important to avoid lens decentration. The inset shows the cross-sectional view of the eye with the IOL correctly positioned in the ciliary sulcus. (From Steinert RF, Arkin MS:. Secondary intraocular lenses. In: Steinert RF, ed. Cataract Surgery: Techniques, Complications, and Management,. 2nd ed. Philadelphia: :Saunders, 2004:433, with permission from Elsevier.)