Modified Piercing Double-Flanged Single-Piece Intrascleral Intraocular Lens Fixation: A Safe, Efficient, And Durable Technique

Since the introduction of the Yamane technique, various surgical modifications have been developed to reduce endothelial cell damage, procedure-induced corneal astigmatism, surgical time, and, most importantly, technical difficulty and cost. Herein, we present a simple, efficient, and versatile sutureless intrascleral intraocular lens (IOL) fixation technique modified from the double-flanged and Canabrava four-flanged techniques, along with its surgical outcomes.

This study was conducted at a tertiary referral center in Taipei, Taiwan, and included patients evaluated and treated in the ophthalmology outpatient clinics and operating rooms between 2023 and 2025 by a single surgeon.

This retrospective cohort study included patients with aphakia, dropped lens, subluxated or dislocated single-piece IOLs without capsular support, or hydrophilic IOL opacification; those with retinal detachment, severe corneal decompensation, or prior ocular trauma were excluded. The modified piercing double-flanged technique used two 7-0 polypropylene sutures passed through the optic–haptic junction of a one-piece IOL 180° apart via a 27-gauge needle inserted 2 mm posterior to the limbus. Flanges were created with electrocautery and embedded in scleral tunnels. Primary outcome was postoperative BCVA; secondary outcomes were IOL-induced and corneal astigmatism.

The technique was performed in 14 eyes of 14 patients. Significant improvement in visual acuity was observed, with mean preoperative and postoperative BCVA of 1.09 ± 0.88 and 0.61 ± 0.53 logMAR, respectively (p = 0.011). There was no significant difference in corneal astigmatism before and after surgery (−1.3 ± 0.81 vs. −1.5 ± 1.0 D, p = 0.174), and postoperative IOL-induced astigmatism remained within acceptable limits (−0.59 ± 0.54 D). No intraoperative or postoperative complications were observed during the follow-up period.

The modified piercing double-flanged intrascleral IOL fixation technique is efficient, straightforward, and easier to learn than existing sutureless intrascleral fixation methods. It is highly versatile, applicable to both non-foldable and single-piece foldable IOLs, and particularly advantageous for patients with IOL dislocation who prefer to avoid the additional cost of IOL exchange while achieving durable long-term stability.