Scleralfixed

Scleralfixed refers to techniques used to secure an intraocular lens (IOL) to the sclera when there is insufficient or absent posterior capsule support. The term encompasses both traditional sutured scleral fixation and newer sutureless methods that anchor the IOL haptics within scleral tunnels or create a scleral flange to hold the lens in place. The goal is to provide stable, centrated posterior segment support while minimizing contact with anterior segment structures.

In sutured scleral fixation, the IOL is positioned so that its haptics are attached to the sclera using sutures passed through scleral or corneal tunnels and tied or anchored in place. This approach has a long history and can provide durable fixation, but it carries risks such as suture erosion, suture breakage over time, and late IOL dislocation, particularly in younger patients or with long follow-up.

Sutureless scleral fixation techniques include intrascleral haptic fixation and flange methods (such as the Yamane technique) or glued IOL procedures. These approaches avoid external sutures by creating scleral tunnels or using adhesive methods to secure the haptics, reducing some suture-related complications. Variants aim to improve wound integrity, decrease surgical time, and promote rapid recovery.

Indications for scleralfixed IOL placement include aphakia with no capsular support, dislocated or subluxated IOLs requiring repositioning, and secondary implantation after complicated cataract or vitreoretinal surgeries. Outcomes are generally favorable for suitable cases, though complications can include IOL tilt, intraocular pressure changes, cystoid macular edema, endophthalmitis, or retinal detachment.

See also: intraocular lens, scleral fixation, Yamane technique, glued IOL.