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Modified four-point scleral fixation of foldable intraocular lens with flexible Hoffman pocket positions

Poster Details

First Author: S.Chen USA

Co Author(s):                        

Abstract Details


To present a modified technique for four-point fixation of IOL with flexible Hoffman pockets positions.


Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan (R.O.C.)


A four-looped-haptics acrylic foldable IOL (Akreos Adapt) is used. Two Hoffman pockets can be constructed either on the same side of IOL or diagonally across from each other, providing additional freedom for surgeons. After IOL injection into the anterior chamber, 10-0 polypropylene (Prolene) with straight needle in one side and 27-gauge needle are used to concatenate the two haptics in each side of the IOL. The IOL is then fixated at the sclera at two points of each side of IOL with 4mm apart in the sulcus plane. 10-0 Prolene was tied with knot embedded in the Hoffman pocket.


Case presentation: a 31-year-old male suffered from penetrating injury of eyeball with corneal laceration and traumatic cataract. After primary repair of the corneal wound and removal of the traumatic cataract with lens aspiration, his best-corrected visual acuity (BCVA) was 20/130. Four months later, he received the modified four-point scleral fixation of IOL with flexible Hoffman pocket positions. After two months, photorefractive keratectomy was performed to reduce corneal scar and astigmatism. The final BCVA is 20/22.


This new technique has several advantages. Using foldable IOL avoids large corneal wound and high astigmatism post-operatively. Moreover, the Hoffman technique eliminates conjunctival excision and scleral flap which may be time consuming and can increase post-operative irritation. In addition, fixation at four points diminishes IOL tilting. Most importantly, this technique offers two different position options for the Hoffman pockets, allowing the positioning of the two pockets to be flexible thus eliminating the need for diagonal placement. This flexibility will be valuable in patients with filtering bleb, corneal scar, or combination with multiple surgery like vitrectomy.

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