Long-term Outcomes of the Flanged Scleral Fixation Technique

To report long-term safety and efficacy of the flanged scleral fixation technique.

This retrospective cohort study was conducted at a single tertiary medical center. Patients who underwent 7-0 polypropylene flanged scleral fixation between 2019 and 2022 and had at least 24 months of follow-up were included. The primary outcome was postoperative complication rate. Secondary outcomes included postoperative uncorrected and corrected distance visual acuity and refraction.

Eighty-nine eyes of 89 patients were included in the analysis. The mean age was 77.83 ± 9.33 years and 51 (57%) were male. In 45 eyes (50%) a subluxated IOL was repositioned and fixated, in 28 eyes (31%) the IOL was exchanged and a new IOL was fixated, and in 16 eyes (18%) secondary IOL implantation and fixation were performed in aphakic eyes with lack of capsular support. The mean follow-up time was 34.49 ± 10.19 months. Loss of intraocular pressure control requiring hypotensive medication and/or glaucoma intervention occurred in 12 patients (13.5%) and corneal pseudophakic bullous keratopathy occurred in 3 patients (3%) who later underwent posterior lamellar corneal transplantation. In 2 patients (2%) a second surgery was required to re-fixate the re-subluxated IOL due to intraocular slippage of one of the flanges.

Flanged scleral fixation showed acceptable long-term anatomical and visual outcomes in this complex cohort. These findings should be interpreted cautiously given the lack of endothelial cell data and the observed postoperative intraocular pressure-related and corneal complications. Further prospective comparative studies with endothelial assessment are needed.