Four-Flanged Intrascleral One Piece Intraocular Lens Fixation – “The Dumbbell Technique"

To report on the clinical outcomes and describe our experiences with the use of four-flanged intrascleral one piece IOL fixation method - “the dumbbell technique”.

A prospective, noncomparative, interventional case series of patients who underwent four-flanged intrascleral IOL fixation - “the dumbbell technique” in Grantham Hospital, Hong Kong SAR from November 2020 to January 2023.

Four-flanged intrascleral IOL fixation with a one piece polypmethyl methylacrylate (PMMA) IOL (Alcon CZ70BD) was performed in all patients included in our case series. 5-O prolene was passed through each eyelet of the IOL and flanged ends were created superiorly and inferiorly with low temperature cautery to fixate the IOL to scleral like a dumbbell.

21 eyes from 20 patients were included in our study. 2 patients had IOL complications which required IOL removal and scleral fixation of IOL; while other patients were aphakic from previous complicated cataract surgeries. The mean visual acuity improved from 1.33 logarithm of the minimum angle of resolution (logMAR) units preoperatively to 0.54 logMAR postoperatively with a mean follow up period of 11.5 months. Postoperative complications included cystoid macula edema in 3 eyes (0.14%) and vitreous hemorrhage in 2 eyes (0.10%) which were self-limiting. There were no incidents of postoperative endophthalmitis or IOL dislocation.

“The dumbbell technique” is a simple, safe and effective way to perform intrascleral IOL fixation in patients with inadequate capsular support. Though a large cornea wound is needed to insert the one piece PMMA IOL with this method, less manipulation is required intraocularly, hence minimizing risks of endothelial injury or haptics damage. There is also lower risk of suture breakage which may lead to IOL dislocation as no knots are necessary.