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. 2025 Oct 15.
doi: 10.1007/s00417-025-06992-6. Online ahead of print.

Real-world outcomes of scleral-fixated intraocular lens: a multi-surgeon study comparing four-point fixation and flanged intrascleral haptic fixation techniques

Stanley S J Poh #  1   2 , Shayne S Tan #  1 , Andrew S H Tsai  1   2 , Sin Yee See  3 , Hla Myint Htoon  4 , Daniel S W Ting  1   2   4 , Ning Cheung  1   2 , Edmund Y M Wong  1   2 , Gavin S W Tan  1   2   4 , Shu Yen Lee  5
Affiliations

Real-world outcomes of scleral-fixated intraocular lens: a multi-surgeon study comparing four-point fixation and flanged intrascleral haptic fixation techniques

Stanley S J Poh et al. Graefes Arch Clin Exp Ophthalmol. .

Abstract

Purpose: To compare outcomes between two scleral-fixed intraocular lens (IOL) (SFIOL) techniques: four-point fixation and flanged intrascleral haptic fixation.

Methods: This was a retrospective study conducted between 2018 and 2022 on eyes that underwent SFIOL using either four-point fixation or flanged intrascleral haptic fixation. We compared the visual outcomes and postoperative complications between groups. Subgroup analyses were performed for eyes that underwent pars plana vitrectomy (PPV), flanged intrascleral haptic fixation with versus without PPV, and high myopia versus non-high myopia.

Results: 304 eyes from 294 patients were included with a mean follow-up duration of 702.62 ± 537.9 days. Four-point fixation demonstrated better best corrected VA at 3 months (0.24 ± 0.35 vs. 0.37 ± 0.60 logMAR, p = 0.032), with a higher proportion of eyes achieving VA 0.3 logMAR or better (80.7% vs. 71.0%, p = 0.132). This difference remains significant in the subgroup of eyes that underwent PPV between four-point fixation and flanged intrascleral haptic fixation (0.24 ± 0.35 vs. 0.39 ± 0.64 logMAR respectively, p = 0.024), specifically among non-highly myopic eyes (0.24 ± 0.34 vs. 0.39 ± 0.60 logMAR respectively, p = 0.043). Postoperative IOL-related complications were comparable between the two techniques (all p > 0.05). Among eyes undergoing flanged intrascleral haptic fixation, those with PPV had higher rates of transient postoperative hypotony compared with those without PPV (12.9% vs. 1.5%, p = 0.006).

Conclusion: Four-point fixation achieved better best corrected VA at 3 months compared with flanged intrascleral haptic fixation, while both techniques demonstrated similar postoperative complication rates.

Keywords: Flanged intrascleral haptic fixation; Four-point fixation; Scleral-fixated intraocular lens; Yamane fixation.

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Conflict of interest statement

Declarations. Conflict of interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the SingHealth Centralized Institutional Review Board (R2074/36/2024) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Financial Disclosures: Nil.

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