Modified sutureless flanged intrascleral intraocular lens fixation in pediatric patients: clinical outcomes over 2 years of follow-up

Purpose To evaluate the long-term visual and anatomical outcomes of modified sutureless flanged intrascleral intraocular lens (IOL) fixation in pediatric patients with insufficient capsular or zonular support. Methods This retrospective case series study included pediatric patients (≤18 years) who underwent flanged intrascleral IOL fixation between January 2022 and Augest 2023 at Beijing Tongren Hospital, with a minimum of 2 years of follow-up. All patients underwent a complete ophthalmic examination. IOL tilt and decentration were automatedly measured by swept-source anterior segment optical coherence tomography, and haptic intrascleral visibility was graded as none or invisible (Grade 0), mild or slight (Grade I), and moderate or obvious (Grade II). Results Fifteen eyes from 11 patients (mean age, 11.5 ± 4.1 years) were included, with a mean follow-up of 29.0 ± 4.4 months. At the final visit, the mean best-corrected visual acuity (BCVA) improved from 0.75 ± 0.57 to 0.21 ± 0.18 logMAR (t = 3.867, P = 0.002). Mean IOL tilt and decentration were 3.99 ± 2.50° and 0.35 ± 0.35 mm, respectively. Haptic visibility was graded as Grade 0 in 13.6%, Grade I in 72.7%, Grade II in 13.6%. There is no case requiring IOL repositioning. Conclusions Sutureless flanged intrascleral IOL fixation demonstrated favorable long-term visual outcomes and excellent IOL stability in pediatric patients. Systematic grading of haptic intrascleral visibility confirmed stable scleral embedding. This technique provides a safe and effective alternative to sutured fixation for secondary IOL implantation in children.