Intrascleral fixation of capsular bag and intraocular lens in cases with large zonular dialysis

Purpose To evaluate the clinical outcomes of sutureless capsular bag and intraocular lens (IOL) fixation with flattened, flanged intrascleral fixation technique in patients with large zonular dialysis. Methods Fifty-five eyes of 51 patients who underwent flattened flanged intrascleral capsular bag and IOL fixation and optic capture for traumatic cataract, subluxated cataract, and pseudoexfoliation syndrome (PEX) with zonular dialysis greater than 180 degrees were included in the study. The main difference of this technique from the Yamane technique is that it has a flattened flange with sharp borders at the haptic tip. Uncorrected visual acuity, corrected distance visual acuity (CDVA), astigmatism, endothelial cell loss, IOL tilt, and intraoperative and postoperative complications were evaluated. Results The mean age of the patients was 57.4 +/- 15.1 years (range 18-83). Of the patients, 28 (55%) were male and 23 (45%) were female. The mean duration of follow-up after surgery was 19.3 +/- 6.5 months (range 12-36). The mean preoperative and postoperative CDVA were 0.71 +/- 0.16 logMAR and 0.13 +/- 0.20 logMAR, respectively (p < 0.001). The mean preoperative and postoperative astigmatism were 2.0 +/- 1.4 D and 1.0 +/- 0.7 D, respectively (p < 0.001). The mean IOL tilt was 5.7 degrees +/- 5.2 degrees. The mean endothelial cell loss was 9% (range 0.9-19.5). Anterior capsular phimosis was developed in 2 eyes (4%). Conclusion The flattened flanged intrascleral technique of the capsular bag combined with optic capture provides good visual outcomes, robust capsular bag-IOL fixation, and minimal adverse events. However, further studies with more patients are needed for long-term results.