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

Spectacle independence has become a standard expectation following cataract surgery. Achieving this goal is particularly challenging in patients lacking capsular support. To address corneal astigmatism in such cases, we employed a four-flanged scleral fixation technique for toric intraocular lens (IOL) implantation. The purpose of this study was to report the refractive and visual outcomes of toric IOL implantation using the four-flanged scleral fixation technique.

Single tertiary medical center in Israel

A retrospective cohort study. Patients who underwent toric IOL implantation for corneal astigmatism using the four-flanged scleral fixation technique were included. Medical records were reviewed, and pre- and postoperative data were collected. The Artis T PL toric IOL (Cristalens) with four closed-loop haptics was fixated to the sclera using 7-0 polypropylene sutures. Primary outcome was postoperative IOL alignment. Secondary outcomes included uncorrected and corrected visual acuity, refractive outcomes, and postoperative complications

Eighteen eyes of 18 patients were included. Mean age was 69 years, and 55% were male. Three eyes underwent secondary IOL implantation following complex ocular trauma, six eyes had IOL implantation after complicated cataract surgery, and nine eyes underwent IOL exchange for subluxated or malpositioned lenses. Mean follow-up duration was 255 days. Mean preoperative corneal astigmatism was 3.5 ± 1.95 D (range, 1.3-9.3 D). No intraoperative complications were documented. Postoperative manifest refractive cylinder averaged 0.87 ± 0.83 D (range, 0-2.5 D). Two patients developed postoperative pseudophakic cystoid macular edema. At final follow-up, all IOLs remained aligned with the intended axis.

Toric IOL implantation using the four-flanged scleral fixation technique appears to be a safe and effective option in eyes without capsular support, even in complex clinical scenarios. The technique provides stable IOL alignment and favorable refractive outcomes, enabling optimal visual rehabilitation despite challenging surgical conditions.