21.1 Introduction

Scharioth and Agarwal reported the intrascleral IOL fixation technique as a sutureless technique for IOL fixation. ^{1 , 2} This technique has become a popular procedure because it has some advantages over conventional trans-scleral suturing of the IOL. ^{3 , 4 , 5 , 6 , 7} Flanged IOL fixation is a new surgical procedure that can be carried out via the conjunctiva in which the haptics of the IOL are strongly fixed to the sclera without using suture or glue. ⁸ This technique is simple but not easy. The surgeon needs to understand some key points of the technique (▶Video 21.1).

21.2 Surgical Technique

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  Pars plana vitrectomy or anterior vitrectomy.

  
  
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  Subluxated crystalline lens or dislocated IOL removal.

  
  
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  A three-piece IOL insertion into the anterior chamber. The trailing haptic must be kept outside to prevent the IOL from falling into the vitreous cavity.

  
  
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  Angled sclerotomies made with a 30-G thin-wall needle through the conjunctiva at 2 mm from the limbs (▶Fig. 21.1 and ▶Fig. 21.2).

  
  
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  Insertion of the leading haptic into the lumen of the needle using a forceps (▶Fig. 21.3).

  
  
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  A second sclerotomy made with a 30-G thin-wall needle at 180° from the first sclerotomy.

  
  
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  Insertion of the trailing haptic into the lumen of the second needle while the first needle was put on the conjunctiva (double-needle technique; ▶Fig. 21.4).

  
  
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  Externalization of the haptics onto the conjunctiva with the needles (▶Fig. 21.5).

  
  
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  Cauterization of the ends of the haptics using an ophthalmic cautery device (Accu-Temp Cautery, Beaver Visitec) to make a flange with a diameter of 0.3 mm (▶Fig. 21.6).

  
  
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  Fixation of the flange of the haptics into the scleral tunnels (▶Fig. 21.7).

  
  
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  Peripheral iridotomy using the vitrectomy cutter after miosis.