Four-point Gore-Tex scleral fixation using a novel “all-in-one” hydrophilic acrylic intraocular lens with integrated eyelets

Purpose: To describe a surgical technique for four-point Gore-Tex scleral fixation of a foldable hydrophilic acrylic intraocular lens (IOL) with integrated eyelets (UnA IOL; Mediphacos, Belo Horizonte, Brazil) and report its postoperative outcomes. Methods: A 62-year-old woman presented with persistent monocular diplopia after cataract surgery with in-the-bag implantation of a three-piece IOL. Examination revealed IOL decentration secondary to zonular dialysis exceeding 120°, accompanied by iridodonesis. The unstable IOL was explanted, and pars plana vitrectomy was performed, followed by implantation of the UnA IOL using a four-point Gore-Tex CV-8 scleral fixation technique. Results: Monocular diplopia resolved entirely on the postoperative day, and best-corrected visual acuity improved from 20/30 preoperatively to 20/20 at one month, with the IOL well centered and stable on ultrasound biomicroscopy. No suture erosion, persistent inflammation, ocular hypertension, or macular edema was observed, and the UnA IOL remained well-centered and stable during the 6-month follow-up. Conclusions: Four-point Gore-Tex scleral fixation using the UnA IOL demonstrated excellent centration, stability, and safety in the setting of significant zonular loss. Its purpose-built design, foldability, and accessibility make it a practical alternative for secondary IOL implantation in eyes lacking adequate capsular support.