Flanged Intrascleral Intraocular Lens Fixation with Double-Needle Technique

Purpose: To report the clinical outcomes of a new technique for transconjunctival intrascleral fixation of an intraocular lens (IOL). Design: Prospective, noncomparative, interventional case series. Participants: One hundred eyes of 97 consecutive patients with aphakia, dislocated IOL, or subluxated crystalline lens who underwent posterior chamber sutureless implantation of an IOL were studied. Methods: Two angled incisions parallel to the limbus were made by 30-gauge thin-wall needles. Haptics of an IOL were externalized with the needles and cauterized to make a flange of the haptics. The flange of the haptics were pushed back and fixed into the scleral tunnels. Main Outcome Measures: Best-corrected visual acuity (VA), corneal endothelial cell density, IOL tilt, and complications were determined. Results: The IOLs were fixed with exact centration and axial stability. The mean preoperative best-corrected VA was 0.25 logarithm of the minimum angle of resolution (logMAR) units; after surgery, it improved significantly to 0.11 logMAR, 0.09 logMAR, 0.12 logMAR, and 0.04 logMAR at 6, 12, 24, and 36 months, respectively (P < 0.01, P < 0.01, P = 0.03, and P = 0.10, respectively). The mean corneal endothelial cell density decreased from 2341 cells/mm(2) before surgery to 2313 cells/mm(2), 2240 cells/mm(2), 2189 cells/mm(2), and 2244 cells/mm(2) at 6, 12, 24, and 36 months, respectively (P < 0.01, P < 0.01, P < 0.01, and P = 0.17, respectively). The mean IOL tilt was 3.4 degrees +/- 2.5 degrees. The postoperative complications included iris capture by the IOL in 8 eyes (8%), vitreous hemorrhage in 5 eyes (5%), and cystoid macular edema in 1 eye (1%). There were no incidents of postoperative retinal detachment, endophthalmitis, or IOL dislocation. Conclusions: We have developed a new technique for intrascleral IOL fixation. The flanged IOL fixation technique is a simple and minimally invasive method for achieving good IOL fixation with firm haptic fixation. (C) 2017 by the American Academy of Ophthalmology