Four-point scleral fixation of an intraocular lens using a fully prethreaded injector and large externally apposed flanges

A new 4-point scleral fixation technique is described for intraocular lens (IOL) implantation in eyes without capsular support using a fully prethreaded injector technique and large externally apposed flanges. Building on established flanged and sutureless methods, this approach standardizes 4-point tension while minimizing intraocular manipulation and preserving corneal working space. Two preloaded 6-0 polypropylene sutures are passed through the eyelets of a 4-eyelet foldable IOL, allowing injector-based delivery through a small corneal incision. Each suture end is externalized through precisely positioned scleral entry sites, cauterized to create broad flanges, and firmly apposed to the scleral surface to achieve stable opposing-force fixation. This technique reduces the risk of suture crossing, posterior subluxation during injection, and late flange-related complications. The method is reproducible, efficient, and designed to facilitate wider adoption of 4-point scleral fixation in complex aphakic eyes.