ESCRS - PP09.08 - One Technique, Different Iol Challenges: Adaptive Flanged Fixation In Zonular Insufficiency

One Technique, Different Iol Challenges: Adaptive Flanged Fixation In Zonular Insufficiency

Published 2026 - 44th Congress of the ESCRS

Reference: PP09.08 | Type: Free paper | DOI: 10.82333/2nt4-zp65

Authors: Dr Fabio Vicente Zavarse Fadul* 1 , Dr Naon Kim Yeon 2 , Dr Alicia Garde González 3 , Dr David Antolín García 4

1Head of the Ophthalmology department,Hospital Universitario de Torrejón,Madrid,Spain;Ophthalmology department,Clínica Central Ocular,Madrid ,Spain, 2Ophthalmology ,Hospital Universitario de Torrejón,Madrid ,Spain, 3Ophthalmology ,Clínica Central Ocular,Madrid ,Spain, 4Head of the Ophthalmology department,Clínica Central Ocular,Madrid ,Spain

Purpose

To describe technical adaptations of a modified Canabrava fixation technique for stabilizing different intraocular lens (IOL) designs in the setting of zonular insufficiency.

Setting

Private and Public ophthalmology practice.

Hospital universitario de Torrejón (public)

Clínica Central Ocular (private)

Methods

Three eyes with lens instability were managed using tailored modifications of a flange-based scleral fixation approach

In a 10-year subluxated capsular bag-PMMA IOL complex, fixation was achieved by positioning the flange loop closer to the haptic-optic junction due to the absence of a conventional anchoring zone

In a previously vitrectomized eye with zonular weakness following retinal detachment surgery, an Akreos Adapt IOL that dropped into the vitreous cavity was repositioned and stabilized

In an intraoperative zonular dialysis during implantation of a toric FineVision IOL, fixation was adapted to align scleral entry sites with the cylindrical axis and improve centration by adjusting suture tension to compensate for residual zonular force

Results

Stable centration was achieved in all cases.

 

In the PMMA case, the patient had preoperative vision of 0.4 only in upright gaze, with no functional vision in other positions. Postoperatively, uncorrected visual acuity improved to 0.7 at one week and 0.8 with correction.

 

The Akreos IOL remained well centered despite limited visual prognosis due to prior retinal pathology.

 

The toric FineVision IOL achieved 0.94 distance and 1.0 near visual acuity with maintained axis stability.

 

No early tilt, decentration, or fixation-related complications were observed.

Conclusions

Targeted adaptation of flange positioning and fixation geometry enabled effective stabilization across rigid PMMA, eyelet-based, and toric premium IOL platforms. Compensation of residual zonular forces through tailored suture tension may expand surgical options for managing complex lens instability in diverse clinical scenarios. The versatility of this approach, including its use in acute intraoperative complications, may support favorable outcomes even in demanding premium toric IOLs.