Toric Iol Implantation Using The Four-Flanged Scleral Fixation Technique In The Absence Of Zonular Support: A Retrospective Case Series

Spectacle-free visual acuity is now considered a standard expectation from cataract surgery. However, meeting these expectations becomes more challenging in patients lacking capsular support. In order to address those needs, we have employed the four-flanged intraocular lens (IOL) scleral fixation technique using toric IOL.

Assaf Harofeh Medical Center

Patients in whom toric IOL was implanted due to corneal astigmatism using the four-flanged scleral fixation technique were included. Patients’ medical records were reviewed, and pre- and postoperative data were collected. We used the 4 closed-loop haptics Artis T PL lens (Cristalens), fixated to the sclera with 7-0 prolene suture, positioned 2.5 mm from the limbus. Primary outcome was postoperative IOL position. Secondary outcomes included uncorrected and corrected visual acuity, refractive results, and postoperative complications.

Six eyes of six patients were included in this study, the average age was 59 years, 50% were females. Three eyes required secondary IOL implantation due to complex trauma involving additional ocular tissue damage, one eye had secondary IOL implantation soon after complicated cataract surgery, and two eyes underwent IOL exchange for subluxated lens. Follow-up time ranged between one to 14 months. Preoperative corneal astigmatism values were 2.3, 4.5, 9.3, 1.7, 6.6, and 4.0D. Postoperative cylinders on manifest refraction were 1.5, 1.25, 6.0, 0.75, 1.75, and 1.5D, respectively. No intraoperative complications where documented. On last follow-up, all IOLs were aligned according to the planned axis.

Fixation of a toric lens using the four-flanged scleral fixation technique is an effective technique, feasible even in the most complex cases. It provides satisfying IOL alignment and stability and allowing the patient to achieve the best possible visual acuity given the challenging circumstances of the case.