A Modified Capsular Hook Implantation Technique for IOL-Capsular Bag Complex Subluxation: Clinical Outcomes From a Comparative Study.

PURPOSE: To introduce a modified capsular hook technique for managing intraocular lens-capsular bag complex (IOLCBC) subluxation and compare its outcomes with conventional transscleral IOL fixation.

METHODS

A modified implantation technique using polypropylene suture hooks introduced from within the capsular bag, combined with transscleral flanged-node fixation was developed to preserve capsular integrity. Seventeen eyes with in-the-bag IOL-CBC subluxation were included: 10 treated with the modified capsular hook implantation technique and 7 with conventional transscleral fixation. Outcomes at ≥6 months were compared, including surgical duration, IOL decentration and tilt, higher order aberrations (HOAs), visual function, postoperative complications, and patient-reported satisfaction.

RESULTS

The capsular hook group had a significantly shorter surgical duration and demonstrated smaller IOL decentration (0.35 ± 0.22 vs 1.23 ± 0.82 mm) and tilt (2.09 ± 1.51° vs 5.76 ± 4.13°) compared with the transscleral fixation group (all P < .05). Corrected distance visual acuity, contrast sensitivity, and total HOA were comparable between groups, whereas internal HOAs and endothelial cell density loss were relatively lower in the capsular hook group. Patient-reported visual function and quality of vision were higher in the capsular hook group. No cases of suture erosion, chronic inflammation, or recurrent IOL subluxation occurred.

CONCLUSIONS

The modified capsular hook technique provides a safe and minimally invasive alternative for managing IOL-CBC subluxation. By preserving capsular integrity, facilitating stable in-the-bag fixation, and offering improved IOL stability, it may serve as a practical option for eyes with compromised zonular support.