The Flanged Hook Technique for Sutureless Refixation of Late Intraocular Lens-Capsular Bag Complex Dislocation: A...

Late intraocular lens (IOL)-capsular bag complex dislocation is an important delayed complication after cataract surgery. This single-patient case report describes a sutureless anterior-segment approach using an unmodified commercially available polypropylene iris hook, which is referred to in this report as the Flanged Hook Technique. A 75-year-old man underwent uneventful cataract surgery, followed by neodymium: YAG posterior capsulotomy 4 months later. Approximately two years after cataract surgery, he developed symptomatic decentration of the IOL-capsular bag complex, and surgical repositioning was planned. After limited anterior vitrectomy through corneal side-port incisions, the straight end of a polypropylene iris hook was inserted into the lumen of a transconjunctival, 30-gauge, thin-walled needle, engaged with the anterior capsulorhexis margin, externalized by withdrawing the needle, thermally flanged with low-temperature cautery, and buried intrasclerally. The existing IOL-capsular bag complex was preserved using this sutureless anterior approach, without IOL explantation. During the limited three-month follow-up period, centration of the IOL-capsular bag complex was maintained without flange exposure, hook disengagement, recurrent decentration, or other notable ocular complications. The best-corrected visual acuity was 1.0 preoperatively, on postoperative day 1, and at 3 months postoperatively; however, the patient's subjective visual disturbance, described as blurred and shimmering vision, improved after refixation. At 3 months postoperatively, the intraocular pressure was 17 mmHg, and the corneal endothelial cell density was 2826 cells/mm². This single case suggests that the Flanged Hook Technique may be a feasible option in selected anteriorly accessible cases of late IOL-capsular bag complex dislocation. However, this technique remains preliminary and off-label, and further cases with longer follow-up are required to evaluate its appropriate indications, durability, and long-term safety.