Outcomes of flanged 6-0 polypropylene intrascleral fixation for repositioning dislocated in-the-bag intraocular lenses

PURPOSE: To assess outcomes of flanged 6-0 polypropylene intrascleral fixation using a 30-gauge ultrathin-walled needle for in-the-bag intraocular lens (IOL) subluxation. SETTING: Department of Ophthalmology of Complexo Hospitalario Universitario, a tertiary referral public hospital, A Coruña, Spain. DESIGN: Retrospective cohort analysis. METHODS: This retrospective case series included patients who underwent in-the-bag IOL repositioning with flanged 6-0 polypropylene intrascleral fixation between February 2020 and October 2024 by a single surgeon (M.V.d.R.S.). Sutures were looped around the haptic, an IOL eyelet, a capsular tension ring, or between 2 eyelets, externalized with a 30-gauge ultrathin-walled needle, and flanged with hand-held cautery before being buried in the sclera. Data collected included preoperative and postoperative intraocular pressure (IOP), number of hypotensive medications, corrected distance visual acuity (CDVA), endothelial cell density (ECD), and intraoperative and postoperative complications. RESULTS: 47 eyes were analyzed with a mean follow-up of 22.36 months. Mean age was 83.28 years; pseudoexfoliation was present in 34 eyes and trauma in 3. CDVA improved ( P < .001) and IOP decreased ( P < .001), with no change in glaucoma medications. ECD declined from 2059 ± 460 to 1890.28 ± 536.62 cells/mm 2 ( P = .074). Main complications included ocular hypertension (n = 4), IOL decentration (n = 2), cystoid macular edema (n = 3), vitreous hemorrhage (n = 3), and aqueous misdirection (n = 1). Secondary surgery was required in 5 eyes: 3 glaucoma surgeries, 2 IOL repositions, and 1 flange burial. CONCLUSIONS: Repositioning of in-the-bag subluxated IOL using intrascleral fixation with 6/0 polypropylene and a 30-gauge ultrathin-walled needle is a simple, minimally invasive, and safe technique.