Scleral suture fixation of a foldable intraocular lens without a scleral flap or groove

This study aims to assess the surgical and visual outcomes of a sutured intraocular lens (IOL) fixation approach performed without creating a scleral flap or tunnel in aphakic eyes without posterior capsule support.

In this retrospective study, we evaluated aphakic patients who underwent surgery using the ab externo scleral fixation technique that involved tying IOL fixation sutures on the sclera and placing the suture ends under the Tenon's capsule without opening the scleral flap. Preoperative and postoperative visual acuity, refraction values, intraocular lens centralization, and operation-related complications were analyzed.

In the study involving 38 patients with an average follow-up period of 8.2 months, the best-corrected visual acuity (BCVA) improved from an average of 1.00 logMAR to 0.10 logMAR. Spherical equivalent refraction decreased from +10.03 D to +0.96 D. Intraocular lens decentration was observed in 7.9% of cases. No intraoperative complications were observed, while 5.2% of patients experienced postoperative corneal edema and 2.6% experienced macular edema.

The results of this study demonstrate that the ab externo scleral fixation technique without a scleral flap or groove is a safe and effective approach for secondary IOL implantation in aphakic eyes. The significant improvement in BCVA (from 1.00 to 0.10 logMAR) and the substantial reduction in spherical equivalent refraction confirm the technique's optical efficacy. The low rates of intraoperative and postoperative complications, along with satisfactory IOL centration in 92% of cases, support the safety profile of this method. By positioning the suture ends beneath Tenon's capsule rather than creating a scleral flap or tunnel, this technique reduces operative complexity. It minimizes the risk of suture exposure and conjunctival erosion, while maintaining reliable IOL fixation.

Due to its short surgical length, low complication rate, and satisfactory visual results, this simplified sutured IOL fixing technique without a scleral flap or tunnel is safe and effective. Suture exposure is reduced, and the procedure is less invasive, with the suture ends under Tenon's capsule. Larger, comparable, and prospective research is needed to assess the method's long-term effects.