Application of a four-flanged intrascleral fixation technique for toric and multifocal intraocular lenses

Abstract

Purpose To report clinical outcomes of a four-flanged intrascleral fixation technique using toric and multifocal intraocular lens. Observations We describe two cases of premium intraocular lens (IOL) implantation after which the patients fully recovered their visual function following a four-point sutureless scleral fixation technique via a 2.8-mm corneal incision. In the first case, a monofocal toric hydrophobic lens consisting of two haptic plates with four holes for suturing was fixated with 5–0 polypropylene monofilament. In the second case, a bifocal hydrophobic lens with the same haptic design was fixated. No conjunctival or scleral sutures, glue, or flap formation was required during the surgery. There were no complications related to the surgical process. Conclusions and Importance A four-flanged intrascleral fixation technique may benefit patients with poor zonular support who have high expectations for postoperative visual quality.

Double-flanged polypropylene technique: 5-year results

“…This allows patients with insufficient zonular support to obtain better visual outcome using premium IOLs. 19…”

“…This allows patients with insufficient zonular support to obtain better visual outcome using premium IOLs. 19 Mahmood et al successfully used the 4-flange technique in a case of severe capsular phimosis following implantation of a toric trifocal IOL. They took advantage of the design of the already implanted IOL (double C-loop haptics) to create 4 points of fixation.…”

Toric trans-scleral plugs IOL to correct aphakia with significant corneal astigmatism

“…Recently Whang et al 11 proposed the use of four-flanged technique for toric IOL fixation with good refractive outcomes after 12 months. While the four point of fixation provides outstanding stability and centration of the IOL without using suture knots, a symmetrical placement of the four fixation points with the astigmatic axis as a reference point is mandatory to achieve the correct alignment of toric lens.…”

Refractive Outcomes of Retropupillary Fixated Iris-Claw Lens for Exchange of the Dislocated Intraocular Lens Using Modified Scleral Incisions

“… 11 In the present study, the SIA was 1.70 ± 1.27 D for the conventional incision, but it was reduced to 0.63 ± 0.37 D and 0.86 ± 0.85 D when the incision was modified into an L-shaped or frown incision. A small-sized corneal incision could be used when the dislocated IOL is cut before extraction and the new IOL is foldable; 19 however, the Artisan aphakia IOL is made of a rigid biomaterial and is therefore not foldable. Our experience with the modified sclerocorneal incision suggests that postoperative visual quality in eyes undergoing retropupillary iris-claw IOL implantation can be improved.…”

“…11 In the present study, the SIA was 1.70 ± 1.27 D for the conventional incision, but it was reduced to 0.63 ± 0.37 D and 0.86 ± 0.85 D when the incision was modified into an L-shaped or frown incision. A small-sized corneal incision could be used when the dislocated IOL is cut before extraction and the new IOL is foldable; 19 however, the Artisan aphakia UDVA, LogMAR 0.32 ± 0.41 0.47 ± 0.49 0.24 ± 0.23 0.06 ± 0.11 0.00-2.00 0.00-2.00 0.00-1.00 0.00-0.40 P = 0.003, P = 0.151 for C vs L, P = 0.536 for L vs F, P = 0.003 for F vs C CDVA, LogMAR 0.18 ± 0.32 0.27 ± 0.39 0.15 ± 0.24 0.02 ± 0.05 0.00-2.00 0.00-2.00 0.00-1.00 0.00-0.40 P = 0.035, P = 0.089 for C vs L, P = 0.728 for L vs F, P = 0.096 for F vs C SE, D −0. IOL is made of a rigid biomaterial and is therefore not foldable.…”