Four-flanged Technique for Scleral Fixation of a Dislocated Four-eyelet Intraocular Lens

Purpose: To define and evaluate the short-term clinical outcomes of the four-flanged technique for scleral fixation of a dislocated four-eyelet intraocular lens (IOL). Methods: Eleven eyes of 11 patients who underwent scleral fixation of dislocated four-eyelet intraocular lenses using a four-flanged technique were studied retrospectively. We measured the best-corrected visual acuity (BCVA), corneal endothelial cell density, intraocular pressure (IOP), spherical equivalent, astigmatism, IOL tilt and decentration, and postoperative complications. Results: The BCVA was 0.25 +/- 0.11 logarithm of the minimal angle of resolution (logMAR) before surgery and 0.14 +/- 0.12 logMAR 6 months later (p < 0.001). The corneal endothelial cell count was 2,427 +/- 384 and 2,367 +/- 298/mm(2) before and after surgery, respectively (p = 0.285). The spherical equivalent was 6.02 +/- 4.90 and 0.11 +/- 0.36 before and after surgery, respectively. There was no significant difference in astigmatism before and after surgery. The mean IOL tilt and decentration were 2.44 +/- 1.68(degrees) and 0.23 +/- 0.09 mm, respectively. The refractive difference was 0.11 +/- 0.24 diopters (D). Postoperative complications occurred in one eye; one flange lay outside the scleral tunnel, triggering hyperemia and conjunctival inflammation. Conclusions: The four-flanged scleral fixation technique for a dislocated four-eyelet IOL improved the BCVA but did not significantly affect corneal endothelial cell loss. The procedure significantly reduced postoperative IOL tilt, decentration, and astigmatism, and may be a useful alternative to scleral fixation of a dislocated four-eyelet IOL. J Korean Ophthalmol Soc 2023;64(9):803-810