Intrascleral 4-flanged technique for in-the-bag intraocular lens subluxation

Purpose: To present a series of cases in which the 4-flanged technique was used in the management of in-the-bag intraocular lens (IOL) subluxation. Setting: Shamir Medical Center, Israel. Design: Retrospective cohort analysis. Methods: Included were consecutive cases with secondary IOL subluxation that underwent scleral fixation with the 4-flanged technique using 6-0 polypropylene and low temperature cautery. Surgeries were performed during September 2019 to April 2020. Postoperative IOL angle tilt was evaluated using high-resolution ocular coherence tomography. Results: Eleven eyes of 11 patients were included. The mean age was 82.7 ± 5.5 years, and 60% were men. Pseudoexfoliation was noted in 82% of patients, and only 1 case was related to trauma. The mean corrected distance visual acuity (CDVA) postoperatively was within 1 line of the original presubluxation CDVA (0.55 ± 0.41 vs 0.54 ± 0.6 logMAR, P =.965). The mean postoperative IOL tilt was 5.78 ± 3.85 degrees. Surgery duration decreased from 70 ± 14 minutes to 39 ± 15 minutes (first to last operations). No intraoperative complications were reported. Postoperatively, transient intraocular pressure elevation, which resolved at 1 week, was recorded in 45% of cases. Cystoid macular edema, which resolved within a few months under topical treatment, was seen in 2 patients. Conclusions: Among a cohort of patients with secondary in-the-bag IOL subluxation, the 4-flanged technique was safe and resulted in satisfactory visual outcomes and a stable IOL position, with a short learning curve.