Clinical Application of the Modified Scleral Tunnel Intraocular Lens Ciliary Sulcus Suture-Fixation Technique.

PURPOSE: To evaluate the visual outcomes, intraocular lens (IOL) positional stability, and impact on the ocular surface following a novel modified scleral tunnel IOL ciliary sulcus suture-fixation technique in eyes without adequate capsular support.

DESIGN

A prospective single-arm cohort study.

METHODS

A total of 48 eyes underwent the modified fixation procedure, which utilized a microcurved needle with 10-0 polypropylene suture to create a scleral tunnel for suture burial. Main outcome measures were assessed preoperatively and at 1 and 3 months postoperatively. Visual function was evaluated by measuring uncorrected distance visual acuity (UDVA) and best-corrected distance visual acuity (BCVA) using standard logarithmic charts and by manifest refraction. IOL position (decentration and tilt) was quantified using anterior segment optical coherence tomography (AS-OCT) with ImageJ software analysis. Ocular surface impact was assessed via tear film break-up time (BUT), corneal fluorescein staining (FL), and the Schirmer I test (SIT).

RESULTS

Visual outcomes significantly improved: postoperative UDVA was 0.41 ± 0.36 logMAR, and BCVA was 0.25 ± 0.32 logMAR, compared to preoperative 1.16 ± 0.65 and 0.61 ± 0.60 logMAR, respectively (both p < 0.001). IOL position was stable, with a mean horizontal and vertical decentration of 0.38 mm and 0.39 mm, respectively, and a mean tilt of 3.34° and 3.42°. Ocular surface parameters showed a transient disturbance at 1 month (BUT decreased, FL increased) but returned to near-baseline levels by 3 months postoperatively.

CONCLUSION

The modified scleral tunnel IOL fixation technique effectively restores visual function, provides excellent and stable IOL positioning, and induces only transient, reversible disturbance to the ocular surface. This method represents a safe and effective surgical option for eyes lacking capsular support.