Figure 1. Procedure steps and final result. (A) Beginning of the procedure, with the eye showing aphakia, subtotal aniridia, and silicone oil droplets. (B) Suture insertion from one temporal sclerotomy and externalization from the adjacent one, using the handshake technique. (C) The same step from the nasal side. (D) Externalization of 2 suture loops from a small limbal incision at 12 o’clock. (E) Ab externo preparation of the lens, with a cow hitch knot centered at the haptic holes. (F) Lens insertion from the enlarged limbal incision. (G) Rotation and pushing of the knot inside the eye. (H) End of the procedure. (I) Final result 6 months after the operation.