Modified ab externo 2-point pierce technique for scleral fixation of single-piece intraocular lenses

Foldable acrylic lenses are the most extensively used 'in the bag' monofocal or multifocal intraocular lenses (IOLs) in cataract surgery, toric lenses in astigmatism, and refractive lens exchange surgeries. When subluxation or dislocation of these lenses is encountered, they must be explanted as they cannot be fixed with conventional scleral fixation techniques. The 'pierce' technique is a novel way of fixing these lenses to the sclera, wherein a 9-0/10-0 polypropylene suture with a straight needle is passed through the IOL at the haptic-optic junction. The ends of the threads are sutured under the scleral flaps in a vertical fashion. This case series highlights the merits of refixing subluxated or dislocated IOLs in a closed or open globe technique and its utility in eyes with weakened capsular bags as it provides good centration, minimal tilt, and applicability to a wider range of foldable IOLs without eyelets, including premium IOLs.