Early clinical outcomes of the trans-ocular threading technique for four-point flanged scleral fixation of intraocular lenses: a case series

Abstract

To evaluate the early clinical outcomes and surgical feasibility of a trans-ocular threading technique for four-point flanged scleral fixation of intraocular lenses (IOLs). This retrospective case series included 12 eyes of 12 patients who underwent four-point flanged scleral fixation using a trans-ocular threading technique with a preloaded four closed-loop haptic intraocular lens (Artis PE, Cristalens, France). A bent 25-mm long 30-gauge needle was introduced 2.5 mm posterior to the limbus and passed across the anterior chamber to a contralateral corneal incision. During IOL delivery, the needle was threaded through the haptic loops, allowing extraocular suture externalization without intraocular suture handling. A 6 − 0 polypropylene suture (Prolene, Ethicon, USA) was secured using a flanged technique with low-temperature cautery. The anterior chamber was maintained with viscoelastic without an infusion system. Clinical outcomes, including corrected distance visual acuity (CDVA), intraocular pressure (IOP), corneal endothelial cell density (ECD), IOL centration, and postoperative complications, were evaluated at a mean follow-up of 3.2 ± 1.1 months (range, 2–5 months). At a mean follow-up of 3.2 months (range, 2–5 months), corrected distance visual acuity (CDVA) improved in 10 of 12 eyes (83.3%), with a mean improvement from 0.86 ± 0.72 to 0.38 ± 0.51 logMAR. After suture revision in one eye with early postoperative IOL subluxation due to insufficient suture tension, all IOLs were well-centered at the final follow-up. Mean preoperative and postoperative IOP did not differ significantly (14.9 ± 2.4 vs. 14.1 ± 2.8 mmHg; P  = 0.43). Mean corneal endothelial cell density (ECD) was preserved at final follow-up (2205 ± 907 vs. 2146 ± 926 cells/mm²; P  = 0.61). Postoperative IOL decentration assessed by anterior segment optical coherence tomography (AS-OCT) was 0.31 ± 0.13 mm (range, 0.04–0.46 mm), with all 12 eyes below the 0.5 mm threshold for clinical significance. One eye developed transient hyphema that resolved spontaneously within one week. No cases of cystoid macular edema, hypotony, or significant intraocular inflammation were observed. The trans-ocular threading technique for four-point flanged scleral fixation demonstrated favorable early clinical outcomes with minimal complications. This approach may reduce intraocular manipulation and maintain anterior chamber stability without the need for an infusion system.