Modified Four-Flanged Intrascleral Fixation of Foldable Intraocular Lenses Using a 1-Inch, 30-Gauge Needle for...

Area of Science:

• Ophthalmology
• Surgical Techniques

Background:

• Intrascleral fixation of intraocular lenses (IOLs) is crucial for managing various ocular conditions.
• The Canabrava technique for four-flanged intrascleral fixation requires modification for improved safety and efficacy.

Purpose of the Study:

• To evaluate the efficacy and safety of a modified four-flanged intrascleral fixation technique for foldable IOLs.
• To assess the use of a 1-inch 30-gauge needle for extraocular suture threading in this procedure.

Main Methods:

• A retrospective case series of 20 eyes undergoing modified four-flanged intrascleral IOL fixation.
• Foldable IOL insertion via a 2.4-mm clear corneal incision with extraocular suture threading using a 30-gauge needle.
• Data collected included visual acuity (UCVA, BCVA), intraocular pressure, refractive outcomes (SE, PE), astigmatism, and complications.

Main Results:

• Significant improvement in uncorrected and best-corrected visual acuity (logMAR UCVA from 1.25 to 0.35, BCVA from 0.53 to 0.15) over 6 months (p < 0.05).
• Mean postoperative spherical equivalent was -0.61 ± 1.08 diopters with a prediction error of -0.25 ± 0.86 diopters.
• No significant changes in endothelial cell density or corneal astigmatism; lens astigmatism reduced. One case each of hypotony and vitreous hemorrhage resolved medically. No IOL dislocation, decentration, or tilt occurred.

Conclusions:

• Modified four-flanged intrascleral IOL fixation with a 30-gauge needle provides stable IOL fixation.
• Extraocular suture threading simplifies the procedure, minimizes intraocular manipulation, and leads to favorable visual outcomes.
• The technique demonstrates a low rate of postoperative complications and issues related to IOL centration or flanges.