Outcomes Of A Novel Four Flanged Intrascleral Fixation Technique Using A Specially Designed Spatulated Needle Attached To A 7-0 Prolene Suture

• To evaluate IOL centration following this new, simplified SFIOL technique.

• To assess visual outcomes at postoperative day 30 in terms of best-corrected visual acuity and spherical equivalent.

• To document intraoperative and postoperative complications associated with the technique.

• To determine the duration of surgery.

This prospective interventional study included aphakic patients with inadequate capsular support who underwent secondary IOL implantation using the novel four-flange scleral fixation technique. The procedure was performed with either a foldable IOL with C-loop haptics or a PMMA IOL.

The procedure involved creating two internal flanges using a specially designed spatulated needle preloaded with 7-0 polypropylene, passed through the IOL dialing holes in PMMA lenses and through the optic–haptic junction in foldable IOLs. Two additional external scleral flanges were fashioned using thermocautery. Clinical outcomes were assessed on POD 1 and POD 30, including best-corrected visual acuity, spherical equivalent, and IOL centration. Intraoperative and postoperative complications, as well as surgical duration, were also recorded.

Mean BCVA improved by one line postoperatively, from 0.35 ± 0.21 LogMAR to 0.26 ± 0.22 LogMAR (p = 0.0043). The mean spherical equivalent improved significantly from 10.47 ± 0.80 D preoperatively to 0.01 ± 0.63 D postoperatively (p < 0.001). IOL centration was achieved in 98.65% of eyes on POD 1 and 97.30% on POD 30; cases with decentration underwent successful surgical repositioning. Early postoperative complications included transient corneal edema, vitreous hemorrhage, knot exposure, IOL decentration, iritis, hypotony, and transient IOL elevation. Late complications comprised cystoid macular edema (CME) and IOL decentration. The mean surgical duration was 33.99 ± 14.73 minutes.

The novel four-flange SFIOL technique demonstrates clinical outcomes comparable to existing methods. The specially designed needle–suture combination aims to address key concerns related to flanging. This technique can be safely performed by an anterior segment surgeon without the need for specialized intraocular lenses or additional instruments. It is compatible with any foldable IOL with C-loop haptics—including toric IOLs—as well as PMMA lenses. The procedure is relatively quick, and its simplified steps enhance the ease of performing what is traditionally considered a complex surgery.