Surgical outcomes of sutureless, glueless intrascleral fixation of intraocular lenses: A prospective interventional study

Objectives: The objective of the study is to evaluate the visual outcomes and post-operative complications of sutureless, glueless intrascleral fixation of posterior chamber scleral fixated intraocular lenses (IOLs) using a modified 26-gauge needle-assisted haptic exteriorisation technique. Materials and Methods: This prospective interventional study included aphakic eyes or eyes with dislocated/subluxated lenses or IOLs undergoing pars plana vitrectomy with sutureless scleral fixation of a three-piece polymethyl methacrylate (PMMA) IOL. The three-piece PMMA IOL (Aurolab) was the preferred lens due to its cost-effectiveness and standard availability in the government hospital setup. All surgeries were performed by a single surgeon between June 2023 and June 2024. Best-corrected visual acuity (BCVA), intraocular pressure and post-operative complications were assessed on postoperative day 1, week 1, month 1, month 3 and month 6. Results: A total of 50 eyes were included. The most common indications were aphakia following complicated cataract surgery and dislocated/subluxated IOLs. Mean BCVA improved significantly from pre-operative levels at final follow-up. Early post-operative complications included transient corneal oedema and mild hypotony, which resolved with conservative management. No haptic breakage was noted during implantation, although haptic bending occurred in a few cases. No cases of endophthalmitis or late dislocation were observed during the follow-up period. Conclusion: Sutureless, glueless intrascleral fixation of IOL using a modified 26-gauge needle technique is a safe, effective and reproducible method for visual rehabilitation in eyes lacking capsular support. The technique avoids suture-related complications, provides good IOL stability and yields favourable visual outcomes. A common challenge encountered during the early learning phase was the technical difficulty of tucking the haptic into the scleral pocket.