Comparative Analysis Of Two Sutureless Scleral-Fixated Intraocular Lens Implantation Techniques: Anatomical Outcomes And Applications Of Anterior Segment Oct

To compare the anatomical and functional outcomes of two sutureless scleral-fixated intraocular lens (IOL) implantation techniques: the FIL SSF IOL (Soleko, Italy) and a three-piece IOL (PU6A, Kowa, Japan) implanted using a modified Yamane technique. The endpoints included IOL tilt and decentration assessed by anterior segment optical coherence tomography (AS-OCT) CASIA2, surgical time, visual outcomes, and postoperative complications.

Prospective multicenter study conducted at the Ophthalmology Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna and the Department of Ophthalmology, “S. Maria delle Croci” Hospital, Ravenna, Italy.

Patients aged ≥18 years requiring secondary IOL implantation due to absent or inadequate capsular support were prospectively enrolled. All patients underwent comprehensive ophthalmic evaluation and were followed for at least 6 months. The FIL SSF IOL was implanted through a 2.4-mm corneal incision, with haptics externalized via 25-G sclerotomies 2.5 mm from the limbus and secured within partial-thickness scleral grooves. The three-piece IOL was inserted through a 2.2-mm incision; haptics were externalized through angled 25-G sclerotomies 2.0 mm from the limbus, cauterized to create flanges, and tucked into scleral tunnels. AS-OCT CASIA2 was performed at 6 months to assess IOL tilt and decentration. Postoperative complications were recorded.

Sixty-seven eyes were included: 33 in the FIL SSF group and 34 in the Yamane group. The main surgical indication was IOL–capsular bag complex subluxation. Total surgical time did not differ significantly between groups; IOL implantation time was significantly shorter in the FIL SSF group (12.03 ± 3.5 vs 21.44 ± 5.8 minutes). At 6 months, AS-OCT showed significantly lower tilt (median [IQR]: 4.3° [1.1°] vs 5.7° [1.8°]) and decentration (0.33 [0.28] mm vs 0.51 [0.45] mm) in the FIL SSF group. Both groups showed significant BCVA improvement, with greater mean improvement in the FIL SSF group (ΔBCVA: 0.59 ± 0.42 vs 0.41 ± 0.26 logMAR). Transient IOP elevation was the most common complication. No complications occurred in over 80% of cases.

Both sutureless scleral-fixated IOL implantation techniques demonstrated good safety and efficacy profiles. The FIL SSF IOL was associated with significantly shorter implantation time and lower tilt and decentration compared with the three-piece IOL implanted using the Yamane technique. These findings suggest improved anatomical stability with the FIL SSF design. Further studies are warranted to confirm these results and to investigate the relationship between IOL tilt, visual acuity, and refractive outcomes.