[Clinical study of scleral suture fixation of astigmatism-correcting intraocular lenses without capsular support]

Objective: To investigate the surgical technique, positional stability and clinical efficacy of scleral suture fixation of single-focus and multifocal toric intraocular lenses (TIOLs) in the ciliary sulcus for eyes without capsular support. Methods: This retrospective case series study enrolled 20 patients (25 eyes) who underwent posterior chamber TIOL fixation with a 9-0 polypropylene suture for both haptics combined with a Z-shaped intrascleral suture technique at the Ophthalmic Center Affiliated to School of Medicine, Shanghai University from December 2023 to December 2024. All eyes were unsuitable for the standard in-the-bag implantation, with indications including lens dislocation/subluxation, aphakia and other conditions requiring intraocular lens (IOL) exchange. Only the right eye of each bilateral patient was included, yielding 20 eyes for final analysis. There were 9 males and 11 females, with a mean age of (25.50±17.20) years. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), astigmatism magnitude, as well as target and actual astigmatic axes were compared before and after surgery. Visual acuities were converted to the logarithm of the minimum angle of resolution (logMAR) for analysis. Postoperative IOL tilt, decentration and surgical complications were also observed. Results: The preoperative UCVA and BCVA were 1.14±0.36 and 0.62±0.45 (logMAR), respectively. The mean corneal astigmatism and total ocular astigmatism were (3.65±2.56) D and (3.15±2.36) D, respectively. The mean follow-up duration was (6.4±1.24) months. At the last follow-up, visual acuity was significantly improved in all eyes. The UCVA and BCVA increased to 0.30 (0.20, 0.70) and 0.20 (0.10, 0.33) (logMAR), respectively, and the total ocular astigmatism decreased to 0.88 (0.50, 1.06) D (all P<0.05). The mean deviation between the target and actual TIOL axis was 2.10°±1.65°. The axial deviation was 0.70°±0.80° from postoperative day 1 to week 1, and 0.25°±0.44° from week 1 to month 1. The mean postoperative horizontal and vertical IOL tilt angles were 4.38°±2.47° and 4.36°±1.95°, and the mean Kappa angle and Alpha angle were (0.41±0.33) mm and (0.35±0.24) mm, respectively. The other postoperative complications were mild and controllable. Conclusions: The scleral suture fixation of single-focus or multifocal TIOLs can significantly reduce astigmatism and improve visual acuity, with favorable positional and axial stability during the follow-up period.