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 (G) ultra-thin wall 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 (VDR). Sutures were looped around the haptic, an IOL eyelet, a capsular tension ring, or between two eyelets, externalized with a 30-G ultra-thin wall needle, and flanged with hand-held cautery before being buried in the sclera. Data collected included pre- and postoperative intraocular pressure (IOP), number of hypotensive medications, corrected distance visual acuity (CDVA), endothelial cell density (ECD), and intra- and postoperative complications. Results: Forty-seven 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 <0.001) and IOP decreased ( p <0.001), with no change in glaucoma medications. ECD declined from 2059 ± 460 to 1890.28 ± 536.62 cells/mm 2 ( p =0.074). 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 prolypropylene and a 30-G ultra-thin wall needle is a simple, minimally invasive, and safe technique.