Scleral Fixation With Mccabe Belt Loop Technique- A Clinical Audit Of Outcomes And Stability In Complex Intraocular Lens (Iol) Rescue.

To assess primary outcome of postoperative Intraocular lens (IOL) stability, alongside secondary visual and safety outcomes following McCabe belt loop flanged intrascleral fixation technique as a rescue strategy for dislocated intraocular lens.

Audit conducted at the Department of Ophthalmology, Frimley Park NHS FoundationTrust Hospital, Surrey, United Kingdom.

A retrospective clinical audit conducted on 8 eyes of 7 patients who underwent scleral fixation of IOL using McCabe technique between June 2023 and October 2025.The surgical procedure involved marking incisions from the limbus,creating 6-0 prolene belt loop around existing IOL haptic,externalised using 27-G needles.The suture ends are cauterised to create terminal bulbs(rivets) and buried within the sclerostomy tracks.The primary outcome measure was IOL stability,assessed by slit lamp biomicroscopy at 1 week,3 months and 6 months,postoperatively.Secondary outcomes included best corrected visual acuity and incidence of postoperative complications(Ocular hypertension,Uveitis Glaucoma Hyphema syndrome,cystoid macular oedema and flange erosion)

This audit involved complex eyes (history of trauma, retinal detachment surgery, glaucoma, and pseudoexfoliation) with a 3-month mean follow-up. Cases comprised 7 in-the-bag dislocated IOLs and 1 scleral-fixated Akreos lens. Intraoperative complications included one case each of corneal epithelial burn and silicone oil prolapse. Primary IOL stability was  achieved in 87.5% at 3 months. Post-operative, 1 patient required secondary intervention for IOL decentration; there was 1 instance of elevated IOP and 1 of corneal edema. No occurence of CME, UGH syndrome, or suture related complications. Visual acuity improved in 4/8 eyes, remained stable in 2/8. Visual decline noted in 2 patients attributed to pre-existing AMD and progressive glaucoma.

The McCabe belt loop technique is an elegant,safe and robust rescue procedure for IOL dislocation, demonstrating consistent anatomical stability and predictable visual outcomes in majority of cases. While this audit supports the use of McCabe technique as a reliable alternative to other methods of intraocular lens fixation, particularly in complex eyes where minimising surgical trauma is critical, the findings are limited by small sample size (N =8) and short term follow up. These preliminary results warrant further investigation with larger, prospective cohorts to assess long term suture integrity, quantitative analysis of IOL position and potential for late onset IOL decentration.