Scleral fixation of toric intraocular lenses – A modified ab-externo 4-point fixation technique

Toric intraocular lenses (IOLs) offer a surgical solution for correcting various degrees of corneal astigmatism. However, their effectiveness relies heavily on a stable capsular bag and precise rotational alignment. In cases where the capsular bag is compromised or absent, alternative fixation techniques are necessary. This surgical technique showcases various methods for securely fixing toric IOLs in diverse clinical scenarios, including single-piece IOLs and Envista IOLs with a hole at the haptic-optic junction. Additionally, we highlight the technique of repositioning and recentering dislocated or decentered toric IOLs, achieving optimal alignment, minimal tilt, and significant astigmatism correction.