Reverse 4-flanged technique for intrascleral fixation of a foldable hydrophobic IOL in the absence of capsular support through a 2.2 mm corneal incision.

Purpose: The purpose of this study was to describe a modified technique for sutureless intrascleral intraocular lens fixation in in patients without capsular support: the reverse 4-flanged technique. Methods: A 2.2 mm corneal incision was made for aphakic patients. The 6-0 polypropylene sutures were threaded through a 30-gauge needle outside the eye. An MDJ® injector was employed to insert the IOL in the eye. A suture-needle snare with 7-0 polypropylene was used to exteriorize the superior end of the sutures through the sclerotomy. The 6-0 polypropylene was heated with a cautery to create the flanges. Results: Nine eyes of nine patients underwent the reverse 4-flanged technique. The median follow-up time was 182 days (range 174 – 195). Best corrected distance visual acuity (BCVA) improved from 20/400 hand movement - 20/33 to 20/120 20/400-20/21. No vitreous haemorrhage, retinal detachment, endophthalmitis, IOL luxation or flange exposure was recorded during the follow-up. Conclusion: The reverse 4-flanged technique maintains the advantages of the original 4-flanged technique in terms of IOL stability while reducing the incision size and surgical manoeuvres performed inside the eye. This modification promises to be a reliable, safe and relatively simple technique to correct aphakia in the absence of capsular support.