Abstract: Objective To evaluate the clinical efficacy and safety of a novel intrascleral fixation technique for intraocular lens (IOL) implantation without creating a scleral flap. Design Retrospective case series. Participants 48 patients (49 eyes), including 25 eyes with aphakia, 7 patients (8 eyes) with dislocated crystalline lenses, 10 eyes with IOL displacement, and 6 eyes with IOL dislocation. Methods All patients underwent intrascleral fixation of IOL without creating scleral flaps. The suture was tunneled through the superficial sclera, leaving an external loop. The needle was redirected along the same path, exiting and tied to the pre-formed loop at the entry site. The knot was buried at the entry point, and the suture thread was then tied to the loop apex, forming a single strand which was subsequently tunneled back through the intrascleral space. Patients were followed up for 6 months. Visual acuity was measured using a standard logarithmic chart and converted to LogMAR. Uncorrected visual acuity (UCVA) was recorded preoperatively and at 6 months postoperatively, while best-corrected visual acuity (BCVA) was recorded preoperatively and at 1 week and 6 months postoperatively. Intraocular pressure (IOP) was measured preoperatively and at 1 week postoperatively using non-contact tonometry. IOL position was assessed postoperatively via slit-lamp microscopy and ultrasound biomicroscopy (UBM). Postoperative complications were monitored. Main Outcome Measures Visual acuity, IOP, IOL position, postoperative complications. Results BCVA at 1 week postoperatively (0.56±0.31)LogMAR was comparable to the preoperative value (0.58±0.42)LogMAR (t=0.268, P=0.39). UCVA at 6 months postoperatively (0.57±0.31)LogMAR was significantly better than the preoperative value (1.43±0.42)LogMAR (t=11.532, P<0.001). BCVA at 6 months postoperatively (0.44±0.30)LogMAR was significantly improved compared to the preoperative level (t=1.899, P=0.03). Preoperative IOP (15.07±5.01 mmHg) was similar to that at 1 week postoperatively (15.43±3.98 mmHg) (t=0.394, P=0.347). During the 6-month follow-up, no cases of infection or IOL dislocation occurred. Postoperative complications included transient IOP elevation in 3 eyes, vitreous hemorrhage in 1 eye, and retinal detachment in 1 eye. Conclusion The follow-up results after 6 months showed that intrascleral fixation of IOL without creating a scleral flap is a simple, effective, and safe surgical technique for treating patients with abnormalities in certain lens capsules or zonules.

Key words: Scleral flapless, Intraocular lens implantation, Intrascleral suture fixation