Three-point transoptical flanged IOL fixation to sclera and cornea: a case report

Late in-the-bag intraocular lens dislocation is a clinically significant complication of cataract surgery, which can develop years after initially successful phacoemulsification and lead to a marked decrease in visual function. Although various techniques of secondary intraocular lens (IOL) fixation are available, so far there is no universal minimally invasive approach ensuring high lens stability and a low risk of intraocular damage, especially in patients with no vitreous, zonular damage, and vitreoretinal history. Therefore, ophthalmic surgery requires new technical solutions to optimize posterior chamber IOL fixation in case of late dislocation. The article describes a clinical case of surgical treatment of a 66-year-old patient with late in-the-bag dislocation of a posterior chamber acrylic IOL into the vitreous 15 years after phacoemulsification. The patient had concomitant risk factors, including high myopia, previous vitrectomy for rhegmatogenous retinal detachment, and controlled open-angle glaucoma. IOL repositioning was performed followed by sutureless transoptical three-point non-collinear flanged fixation to the sclera and cornea. The technique involved suturing the periphery of the lens optic at three points to create multiple fixation vectors. In the postoperative period, uncorrected and best corrected visual acuity increased, and the IOL was stable and centered without any signs of tilt or decentration. Optical coherence tomography and ultrasound biomicroscopy confirmed correct anatomical lens position, no contact with the iris or cornea, and safe intracorneal position of the flanges. The presented clinical case demonstrates that three-point non-collinear transoptical flanged fixation can reliably stabilize the IOL in case of late dislocation and anatomical challenges. The conclusions are based on a single case and require further clinical confirmation in a larger patient population.