Intrascleral fixation with double-flanged prolene: a stable technique for intraocular lens implantation

Purpose: To evaluate the efficacy and safety of a double-flanged prolene (DFP) intrascleral fixation technique for intraocular lens (IOL) implantation in eyes lacking capsular support. Methods: This retrospective study included 59 eyes (59 patients) undergoing IOL fixation via DFP (n=30) or Yamane flanged (YF; n=29 techniques (November 2019–January 2024). Surgical duration, intraocular time, best-corrected visual acuity (BCVA), endothelial cell density (ECD), IOL position, and complications were assessed. Results: The DFP group had shorter total surgical (32.70±3.21 vs. 42.80±2.63 minutes, P <0.001) and intraocular times (4.42±0.77 vs. 10.95±0.82 minutes, P <0.001). The median BCVA improved from 20/50 (Snellen) to 20/36 (Snellen) at the last visit (P<0.001), with a lower ECD loss (77.67±16.22 vs. 216.45±60.33 cells/mm 2 , P<0.001).YF had higher complication rates (iridemia, cystoid macular edema, haptic exposure; P =0.039). IOL tilt/decentration increased comparably in both groups. Conclusion: The DFP technique offers a safe, efficient alternative to YF for IOL fixation in eyes without capsular support, providing stable positioning, improved visual outcomes, and reduced endothelial cell loss.