Scleral fixated intraocular lens techniques for the vitreoretinal surgeon: an update

To describe recent evidence regarding surgical techniques for secondary scleral fixation of intraocular lenses (IOLs), with attention to information most relevant to the surgical practice of vitreoretinal surgeons.

Recent studies have reported favorable outcomes in patients treated with scleral fixation of IOLs using Gore-Tex suture and flanged intrascleral haptic fixation (ISHF). ISHF can be achieved using trocar-cannulas or double needle-based techniques. Recent data has focused on refractive outcomes data, as well as postoperative complications related to specific IOL choices, including haptic breakage, rotation/ tilt, and opacification. Studies directly comparing Gore-Tex sutured and ISHF techniques offer additional insights.

Favorable refractive and surgical outcomes can be achieved using both sutured and sutureless scleral fixation techniques. These techniques can be combined effectively with pars plana vitrectomy (PPV) and are thus well suited for the skillset of a vitreoretinal surgeon. Future studies on iris-based fixation techniques and IOL types not yet available in the United States will be of interest. As these techniques are more widely used, prospective data as well as longer term outcomes will continue to clarify their risk/benefit profile.