Scleral Suture Fixation Research Articles

Comparison of outcomes between modified double-flanged sutureless scleral fixation and conventional sutured scleral fixation

This retrospective study aimed to compare the outcomes of modified double-flanged sutureless scleral fixation versus sutured scleral fixation. Medical records of 65 eyes from 65 patients who underwent double-flanged scleral fixation (flange group) or conventional scleral fixation (suture group) between 2021 and 2022 were reviewed. Visual and refractive outcomes, as well as postoperative complications, were compared 1, 2, and 6 months after surgery. We included 31 eyes in the flange group and 34 eyes in the suture group. At 6 months postoperatively, the flange group showed better uncorrected visual acuity (0.251 ± 0.328 vs. 0.418 ± 0.339 logMAR, P = 0.041) and a smaller myopic shift (− 0.74 ± 0.93 vs. − 1.33 ± 1.15 diopter, P = 0.007) compared to the suture group. The flange group did not experience any instances of iris capture, while the suture group had iris capture in 10 eyes (29.4%; P < 0.001). In the flange group, all intraocular lenses remained centered, whereas in the suture group, they were decentered in 8 eyes (23.5%; P = 0.005). The double-flanged technique not only prevented iris capture and decentration of the intraocular lens but also reduced myopic shift by enhancing the stability of the intraocular lens.

A novel custom bent 27G needle-guided suture snare technique for scleral fixation of posterior chamber intraocular lenses

PURPOSE: To describe a custom bent 27G needle-guided suture snare technique for scleral fixation of posterior chamber intraocular lenses (PCIOL). METHODS: An 8-0 polypropylene suture was threaded into the lumen of a custom bent 27G needle, and the needle tip was advanced into the eye from the IOL fixation point. The suture was threaded through the posterior limbal incision inside the IOL haptic loop and pulled out. The needle tip was advanced into the eye again, going around the IOL haptic loop through the same limbal incision. The suture was threaded in again, and the needle was withdrawn from the eye, completing fixation of the IOL haptic loop. The suture knot was buried in the stroma of the sclera. RESULTS: The technique was performed in 10 eyes of 10 patients, with a preoperative logarithm of the minimum resolution angle corrected visual acuity of 0.73 ± 0.55 (Snellen 20/107), improvement of 0.24 ± 0.27 (Snellen 20/35) at the final follow-up visit, and a mean postoperative PCIOL tilt of 2.78 ± 1.32°. There were no cases of pupillary capture or suture-related complications during follow-up. CONCLUSION: The curved needle-guided suture snare technique provides a simple minimally-invasive method of scleral suture fixation of PCIOL.

Z-suture scleral fixation intraocular lenses: A refractive and safety report.

Scleral fixation of intraocular lenses constitutes a surgical option in cases where there is inadequate capsular support or zonular insufficiency. Knotless techniques, such as the z-suture technique, avoid suture-related complications, such as conjunctival erosion or exposure. The purpose of this study was to evaluate the visual outcomes and postoperative complications of patients who underwent scleral z-suture fixation of the Akreos AO® intraocular lenses. A retrospective, observational study was conducted, including 22 eyes of 20 patients who underwent Akreos AO® intraocular lenses using the z- suture scleral fixation technique. The mean age of the patients was 55,64 ± 28,47 years old, and the mean follow-up time was 25,64 months. The most common indication for surgery was previous complicated cataract surgey. The mean postoperative spherical equivalent was +0,058D ± 0,79D, with values ranging from - 1,50D to +1,00D. Mean best-corrected visual acuity was 0,178 ± 0,15 logMAR. Intraocular pressure was 15,07 ± 2,56 mmHg on the day after surgery, and 16 ± 2,15 mmHg 1 month after. No suture-related complications were observed in any patient postoperatively. One patient had a slight inferonasal lens dislocation and another patient had a severe case of herpetic keratitis posoperatively. The knotless z-suture technique appears to be a reliable and safe way to fix an intraocular lens in the sclera, regardless of the patient's age. Our results show good visual results and predictable refractive outcomes. Decades of follow-up may be necessary to assess the long-term risk of lens dislocation.

SCLERAL SUTURE FIXATION FOR DISLOCATED SILICONE PLATE HAPTIC INTRAOCULAR LENS.

To describe results in two cases of a dislocated silicone plate haptic intraocular lens managed with vitrectomy and repositioning with scleral suture fixation. Small case series. Two patients presenting with dislocated silicone plate haptic intraocular lens underwent a 23-gauge vitrectomy with a "handshake" maneuver to pass a 9-0 prolene suture through the positioning holes to allow scleral fixation. Best-corrected visual acuity was returned to predislocation Level 2 and 8 months after the vitrectomy. Silicone plate haptic intraocular lens can be managed with scleral suture fixation using this adapted technique, avoiding removal and exchange techniques. These are the first reported cases of silicone plate haptic intraocular lens managed with scleral suture repositioning.

Laser Photo-Cauterization for the Management of Exposed Polypropylene Scleral Fixation Sutures.

Laser Photo-Cauterization for the Management of Exposed Polypropylene Scleral Fixation Sutures.

Quaternary Knot Technique: Suture Knot Burial without Scleral Flap or Incision for Trans-scleral Fixation.

Despite the introduction of novel sutureless posterior chamber intraocular lens (IOL) fixation techniques, some conditions still require suture-assisted scleral fixation. If the scleral fixation suture knot is left directly under the conjunctiva, it may become exposed, resulting in an increased risk of endophthalmitis. To avoid this problem, we offer a new alternative, simple, and safe way for burying the end of the suture using knots in this report.

Scleral Suture Fixation of Dislocated Posterior Chamber Intraocular Lens: Modification for Tapered Haptics.

To present a surgical modification to a previously published technique that allows repositioning and scleral fixation of one-piece acrylic intraocular lenses with tapered haptics. A retrospective review of three consecutive cases. Our technique modification enables repositioning using scleral suture fixation of one-piece intraocular lenses with tapered haptics by looping the haptic at its proximal, notched junction to the optic with the polypropylene suture. The suture knot is internalized which effectively suspends the intraocular lens and allows for better adjustment of the intraocular lens centration. Two cases were endocapsular dislocations; the third case was dislocated extracapsularly due through a posterior capsule rupture. All showed adequate lens centration at 3 months of follow-up. One case had suffered a vitreous hemorrhage a month postoperatively that is clearing. Repositioning using scleral fixation of one-piece intraocular lenses with tapered haptics is possible with a minor technique modification. This offers an alternative to intraocular lens exchange.

Supplemental Toric Intraocular Lenses in the Ciliary Sulcus for Correction of Residual Refractive Astigmatism: A Review.

This study conducted a critical review of the peer-reviewed literature on the use of supplemental toric intraocular lenses (STIOL) in the ciliary sulcus to correct residual refractive astigmatism. This review used PubMed as a database from 1 January 2010 to 13 March 2023. According to the inclusion and exclusion criteria defined, 14 articles were selected for the current review. The data of 155 eyes were analyzed. Most of the studies reviewed had a short follow-up and poor or limited design, including case reports, case series, and retrospective cohorts. The follow-up period ranged from 43days to 4.5years. STIOL rotation was the most frequently described complication in the literature, with a mean rotation of 30.48 ± 19.90°. These patients required repositioning in 50 of 155 eyes (32.25%). Moreover, four eyes (2.58%) required scleral fixation sutures and two eyes (1.29%) iris fixation. Other complications were high intraocular pressure (3 eyes, 1.93%), transient corneal edema (2 eyes, 1.29%), corneal decompensation (2 eyes, 1.29%), and pigment dispersion (1 eye, 0.64%). From the total, 57.41% of eyes (89 eyes from 155) achieved within ± 0.50D of target refractive astigmatism. It is important to highlight that at least 52 eyes out of the 155 (33.54%) had an abnormal cornea with irregular astigmatism. STIOL seem to offer good visual and refractive outcomes. However, STIOL showed variable rotational stability, especially in some platforms. Further studies with a more robust design, methodology, and standardized analysis methods are needed to confirm these trends.

Observation of the curative effect of scleral suture fixation technique with four-loop foldable intraocular lens.

The objective of the study was to evaluate the curative effect of a modified technique of scleral suture fixation with a four-loop foldable intraocular lens (IOL) for eye with inadequate capsule support. This was a retrospective study of 22 eyes with inadequate capsule support of 20 patients who underwent the scleral suture fixation technique with 9-0 polypropylene suture and foldable four-loop IOL implant. Preoperative and follow-up data were collected for all patients. The mean follow-up was 5.08 ± 0.48 months (range: 3-12 months). The mean pre- and postoperative log of minimum angle of resolution (logMAR) uncorrected distance visual acuity was 1.11 ± 0.32 versus 0.09 ± 0.09 (P < 0.001). The mean pre- and postoperative logMAR best corrected visual acuity was 0.37 ± 0.19 versus 0.08 ± 0.07 (P < 0.001). The intraocular pressure (IOP) increased briefly (range: 21-30 mmHg) in eight eyes on the first day postoperatively and returned to normal within 1 week. No IOP drops were used postoperatively. The IOP was 12-19.3 (13.72 ± 1.28) in this follow-up, which had no significant difference compared to the preoperative IOP (t = 0.34, P = 0.74). At this follow-up, there was no hyperemia, local hyperplasia, obvious scar, suture knots, or segment ends observed under the conjunctiva, as well as no pupil deformation or vitreous hemorrhage. The mean postoperative IOL decentration degree was 0.22 ± 0.08 mm. At the 7-day follow-up postoperatively, one side of the IOL was dislocated to the vitreous cavity in one case, which was resolved by reimplantation of a new IOL in time with the same technique. Scleral suture fixation technique of a four-loop foldable IOL was a feasible operation method for an eye with inadequate capsular support.

Commentary: When in a fix, rely on four-point intraocular lens fixation.

This study[1] on Observation of the curative effect of scleral suture fixation technique with four loop foldable intraocular lens is appreciable as it deals with a difficult technique, which has been described and illustrated well in the manuscript. Every ophthalmologist encounters the problem of inadequate capsular support, whether preoperative or intraoperative. It is imperative and crucial to learn how to tackle it and fix an intraocular lens (IOL) to provide good postoperative vision. As polypropylene sutures are non-absorbable, the 9-0 sutures used in this study have the advantage of a greater diameter and cross-sectional area than 10-0 polypropylene suture and will provide permanent wound support; the color blue helps in easy identification and the tensile strength is excellent.[2] Published studies on the use of 9-0 polypropylene sutures in scleral fixation of IOLs are very few.[3] The four-point IOL fixation to fixate the four haptics has been reported to provide a variety of advantages, including enhanced IOL stability and centration, avoidance/minimal of IOL tilt or postoperative pupil capture, and posterior segment complications.[4,5] However, there are a few concerns: The follow-up appears to be too short, with a range of 3–12 months, compared to other studies.[6,7] In eight eyes of this study, having elevated IOP, no medication was used though the IOP stabilized within a week. It may have been better to lower the IOP in the initial stages to prevent any damage. The central corneal thickness and applanation tonometry for the corrected IOP would have added further value. In one patient, it is mentioned that one side of the IOL was dislocated into the vitreous, yet another IOL was implanted and secured by the same technique. In statistical analysis ;newer version of SPSS formula would have been better to use instead of SPSS 16.0. The measurement of IOL tilt has been done at only one month postoperatively in the study. The postoperative endothelial count could have been compared to the preoperative count to provide more valuable insight. The postoperative UCVA was 0.09 ± 0.09, which was significantly better than the preoperative UCVA (t = 13.28, P < 0.001). The quality of vision further improved on correction, and postoperative BCVA was 0.08 ± 0.07, which was significantly better than preoperative BCVA (t = 6.89, P < 0.001). The potential drawback of the type of IOL used is that it is made of a hydrophilic acrylic material, in which opacification can occur. Cases having inadequate capsular support are not only complicated but require skill, expertise, and mentorship. When a surgeon is faced with such a patient, the onus lies only on them to give the best outcome. The importance of the study lies in the management of a complication or condition that can cause a devastating effect on vision. The difficult yet effective procedure described and analyzed is a valuable tool to a solution in a challenging situation.

Supracapsular scleral sutured intraocular lens implantation in anterior segment dysgenesis patients with ectopia lentis.

To describe a new strategy to manage ectopia lentis in ASD patients assessing the visual outcomes and safety of supracapsular scleral sutured intraocular lens implantation and analyzing the accuracy of different intraocular lens (IOL) power calculation formulae. Eight patients with ASD (13 eyes) were underwent supracapsular scleral suture fixation of posterior chamber (PC) IOL without capsular extirpation. The preoperative and postoperative clinical features were compared. The prediction error values from four formulae (SRK/T, Holladay 1, Hoffer Q, Haigis), with or without Wang-Koch (WK) adjustment, were calculated for the cases. Zonulodialysis and premature cataracts could be the main reason for the decreased vision in patients with ASD. There was a significant improvement in best corrected visual acuity on 3-month follow-up after applying supracapsular scleral suture fixation of PC IOL. The prediction errors of the different formulae showed a slight tendency towards postoperative myopia. The Haigis formula with WK adjustment showed the best performance. Supracapsular scleral suture fixation of IOLs for retaining the capsule-zonule barrier is a good option for ASD patients. The Haigis formula is recommended for ASD patients treated with supracapsular scleral suture fixation of IOLs. The predicted IOL power should be reduced based on the effect of the new anatomic position of the IOL to achieve a satisfactory visual outcome.

Combined Temporary Pupilloplasty and DSEK in an Eye With a Hydrophilic Acrylic Intraocular Lens to Prevent Opacification: A Case Report.

The aim of this study was to describe a case of temporary pupilloplasty during Descemet stripping endothelial keratoplasty to prevent opacification of a hydrophilic acrylic intraocular lens (IOL). A 60-year-old man presented with corneal edema in the left eye after a traumatic cataract removal and scleral suture fixation of a hydrophilic acrylic IOL (Akreos, Bausch + Lomb, Bridgewater, NJ). Descemet stripping endothelial keratoplasty with temporary pupilloplasty was performed. The pupilloplasty was lysed with neodymium:YAG laser on postoperative day 5 after the air bubble was no longer present. At 1 year after surgery, the patient did not develop IOL opacification despite the intracameral air used during the surgery. Opacification of hydrophilic acrylic lenses is a visually significant complication of intracameral gas from endothelial keratoplasty. Our case demonstrates the potential to prevent IOL opacification in a patient with a hydrophilic acrylic IOL by using temporary pupilloplasty.

Long-term risk of suture breakage after scleral fixation of late in-the-bag intraocular lens dislocation with a polypropylene 10-0 suture.

To investigate the long-term risk of suture breakage after scleral fixation with a polypropylene 10-0 suture in eyes with late in-the-bag intraocular lens (IOL) dislocation. Oslo University Hospital, Oslo, Norway. Retrospective case series. Patients operated with scleral suturing of late in-the-bag IOL dislocation from 2007 to 2016. 192 eyes (176 patients) operated with scleral suture (polypropylene 10-0 suture) fixation of a dislocated IOL-capsule complex were identified; 91 patients (47%) were men. The mean follow-up after the operation was 6.2 (95% CI, 5.7-6.7) years, and 98 patients (56%) deceased during the study. 11 eyes (6%) (11 patients) had suture breakage that required reoperation with a mean time of 5.5 (3.4-7.6) years after IOL repositioning surgery. These patients had a mean age of 73.5 (67.9-79.2) years at the time of the operation for late in-the-bag IOL dislocation vs 81.3 (79.8-82.9) years for patients who did not experience this complication ( P = .004). No cases of late endophthalmitis were registered. The long-term risk of suture breakage was quite low after scleral fixation of late in-the-bag IOL dislocation, particularly in the oldest patients. Hence, the polypropylene 10-0 suture seems to be a safe option for scleral fixation in this patient group.

Clinical Study of Intraocular Lens Implantation by Scleral Suture Fixation after Lensectomy and Vitrectomy

Objective: To investigate the surgical techniques and clinical significance of intraocular lens implantation by scleral suture fixation after lensectomy and vitrectomy. Methods: According to the inclusion and exclusion criteria, 19 cases (20 eyes) were selected for IOL implantation by scleral suture fixation after lensectomy and vitrectomy. The uncorrected visual acuity (VA), best-corrected visual acuity (BCVA), intraocular pressure (IOP), preoperative IOL position and surface clarity, and complications were recorded, analyzed and compared. Results: In 20 eyes of 19 patients who underwent IOL implantation by scleral suture fixation in this study, both VA and BCVA after surgeries were significantly improved compared with those before surgeries (P&lt;0.05). 11 eyes of 10 patients had IOP ≥ 21mmHg before surgeries. Three months after surgeries, IOP of all these affected eyes were within 21 mmHg, and no affected eyes required the application of ocular hypotensive drugs. Three months after surgeries, 17 eyes of 16 patients (85%) had centered IOL position and 3 eyes of 3 patients (15%) had slightly tilted IOL, all of these tilted IOLs were in patients with ocular trauma and all of them were found to be caused by scar adhesion in the peripheral part. In two eyes, the IOL optical edge was completely blocked by the pupil, which was only found after dilating the pupil. The pupil of one eye was traumatic and irregularly dilated, and the edge of the optical part of IOL was exposed. In two eyes of two patients who underwent silicone oil removal and IOL fixation during the same surgery, a small number of silicone oil droplets were found on the surface of IOL in the early stage after surgeries, and in the later stage, small flakes of pigment granules were observed. During the 3-month postoperative follow-up period, no patient had complications such as IOL dislocation, exposure of fixation suture, retinal detachment and corneal endothelial decompensation. Conclusion: For patients ....

Outcomes of a Simple Lateral Rectus Belly Transposition Procedure Combined With Ipsilateral Antagonist Recession for Vertical Rectus Palsy.

To report the surgical effects of a combination treatment comprising the lateral rectus belly transposition (LRBT) procedure, without muscle splitting or disinsertion, and ipsilateral antagonist recession for vertical rectus palsy. The medical records of consecutive patients who underwent the LRBT procedure between 2017 and 2020 were reviewed. Preoperative and postoperative deviation in primary position, preoperative and postoperative scale of duction of the palsied muscle, any induced horizontal or torsional deviation, and other complications were collected. Thirteen patients were identified: 10 with inferior rectus palsy and 3 with superior rectus palsy. The mean postoperative follow-up time was 20.4 ± 8.0 months. Eleven patients (84.6%) underwent simultaneous recession of the ipsilateral antagonist muscle of the palsied vertical rectus. After surgery, the mean vertical deviation improved from 31.4 ± 16.4 to 1.9 ± 3.6 prism diopters (PD) (P < .001). The mean vertical duction limitation of the palsied muscle improved from -2.7 ± 0.6 to -0.6 ± 0.5 (P = .001). In one patient, the scleral fixation suture was removed due to continuous reverse vertical diplopia. The total success rate was 76.9%. No induced horizontal deviation was noted. Anterior segment ischemia or other severe surgical complications did not occur. The LRBT procedure can be effective, safe, and reversible in patients with vertical rectus palsy. It allows for the option of simultaneous ipsilateral antagonist recession, and it is especially valuable in patients whose vertical duction deficiency is worse in abduction but mild in adduction. [J Pediatr Ophthalmol Strabismus. 2022;59(6):396-404.].

Comparison of two techniques in posterior lens dislocations: Scleral suture fixation vs. modified Yamane intrascleral lens fixation

To compare the use of Yamane flanged intrascleral haptic fixation and scleral suture fixation (SSF) techniques in combination with pars plana vitrectomy (PPV) for treatment of posterior lens dislocations. Patients who underwent PPV and scleral fixated IOL implantation due to subluxation/luxation of the crystalline lens/intraocular lens (IOL) were included in this retrospective study. The Yamane group included patients who underwent Yamane flanged intrascleral haptic fixation technique, while the SSF group consisted of patients who underwent conventional SSF. All patients underwent comprehensive ophthalmologic examinations preoperatively and postoperatively. Intraoperative and postoperative complications were recorded. The Yamane group comprised of 39 eyes of 39 patients, and the SSF group included 35 eyes of 35 patients. Postoperative complications included hyphema (Yamane group: 2/39 (5.1%); SSF group: 0/35 (0%)) IOL decentration (Yamane group: 5/39 (12.8%); SSF group: 0/35 (0%)), corneal edema (Yamane group: 4/39 (10.2%); SSF group: 0/35 (0%)) cystoid macular edema (CME) (Yamane group: 1/39 (2.5%); SSF group: 3/35 (8.5%)) and retinal detachment (Yamane group: 1/39 (2.5%); SSF group: 1/35 (28.5%). The mean surgery time was significantly lower in the Yamane group compared with the SSF group (P<0.001). No cases of hypotony, conjunctival erosion, haptic exposure or endophthalmitis were encountered throughout follow-up. SSF remains a safe and effective technique for management of posterior lens dislocations. The Yamane intrascleral IOL fixation technique is an effective alternative to conventional SSF, which has a relatively steep learning curve. Postoperative complications, including IOL tilt and decentration, may be experienced in the initial cases.

Suture-needle snare for scleral fixation.

Current scleral suture fixation techniques pose challenges for highly complex eyes. A scleral suture fixation technique using a snare that is fashioned out of a 27-gauge needle and 8-0 nylon suture is described. This technique is well-suited for scleral suture fixation in complex eyes because it reduces risk factors for intraoperative and postoperative complications, simplifies intraocular maneuvers, minimizes surgical trauma, and does not require specialized microinstrumentation.

Knot-free suture scleral fixation of dislocated intraocular lenses: clinical results of a novel surgical technique.

To describe and report surgical outcomes of a novel, knot-free technique to manage dislocated intraocular lenses (IOLs). Beyoglu Eye Education and Research Hospital, Istanbul, Turkey. Retrospective observational clinical study. The files of 47 patients were retrospectively reviewed, and the patients who had a follow-up time of 6 months or more were included in this study. The surgery of every case was watched for the surgical complications and calculation of the surgical time. The postoperative complications and success rate were specifically tabulated. Thirty-five eyes of 35 patients were included in this study (23 men, 12 women; mean age 63.1 ± 19.2 years). The mean follow-up time was 22.5 ± 9.9 months. The mean surgical time was 28.2 ± 6.8 minutes. Corrected distance visual acuity improved significantly after surgery (P = .001). Anatomic success rate was 97.1% after a single surgery. Most common complications included transient intraocular pressure (IOP) elevation (n = 2), persistent IOP elevation (n = 1), mild IOL tilt (n = 1), mild IOL decentration (n = 1), secondary IOL dislocation requiring intervention (n = 1), transient corneal edema (n = 1), and bullous keratopathy (n = 1). Knot-free suture scleral fixation of dislocated IOLs was a minimally invasive approach for the management of dislocated IOLs and required only two 20-gauge corneal incisions without the need for scleral flaps or incisions. This technique had a low complication rate and delivered successful results in most cases.

Late Dislocation of In-the-Bag Intraocular Lens in Three Patients with Multiple Chorioretinal Atrophy Associated with Sarcoidosis

PurposeA late dislocation of an in-the-bag intraocular lens (IOL) is strongly associated with pseudoexfoliation and less with retinitis pigmentosa, prior vitreoretinal surgery, and uveitis. We present our findings of late in-the-bag IOL dislocation in three patients with multiple chorioretinal atrophy associated with sarcoidosis.MethodsObservational study of three elderly female Japanese patients with a history of uveitis from sarcoidosis who presented with a late dislocation of an in-the-bag IOL.ResultsThe late in-the-bag IOL dislocation occurred in the convalescent/quiescent stage of the sarcoidosis. Peripheral multifocal chorioretinal atrophy was the main manifestation in all patients who were diagnosed with definite or presumed sarcoidosis. The dislocated IOLs were successfully removed and new IOLs were implanted with scleral suture fixation followed by no remarkable active uveitis.ConclusionClinicians should be aware that patients with peripheral multifocal chorioretinal atrophy associated with sarcoidosis can have a late in-the-bag IOL dislocation.

Modified Four-Point Scleral Suture Fixation Technique for Repositioning a Dislocated Intraocular Lens in the Absence of Capsule Support

Purpose. To study the efficacy of a modified four-point fixation technique for the repositioning of a dislocated intraocular lens (IOL) with four eyelets in the absence of capsule support. Methods. Four patients with dislocated four-eyelet hydrophilic acrylic IOLs (Akreos AO60) were enrolled. The modified technique combined four-point fixation with intrascleral sutures and suture burying. The technique minimized the limbus incision to 1 mm with no externalization of the IOL or its haptics. Follow-ups included routine ophthalmic examinations, corneal endothelial cell counts, and measurement of IOL tilt and decentration (measured using Pentacam® HR images). Results. The IOLs were successfully repositioned in all cases. After a mean follow-up period of 19.75 ± 7.85 months (range: 8 to 24 months), the patients’ best-corrected vision acuity (BCVA (LogMAR), before: 0.63 ± 0.36, after: 0.58 ± 0.43, P = 0.604 ) and intraocular pressure (pre 13.35 ± 0.85 mmHg, post 14.80 ± 2.03 mmHg, P = 0.150 ) remained unchanged. Corneal endothelium density decreased about 6.84 ± 2.97%. In all cases, the IOL was well positioned during the follow-up. At the final visit, the average IOL tilt was 1.36 ± 0.35° horizontally and 1.31 ± 0.14° vertically. The average IOL decentration was 0.23 ± 0.12 mm horizontally and 0.18 ± 0.13 mm vertically. Conclusions. With this modified technique, dislocated IOLs with four-eyelets could be treated safely with favorable outcomes.