Novel modified sutureless, glueless and flapless scleral fixated intraocular lens

Purpose: The purpose of the study was to assess the outcome, complications, and its predictors in novel modified sutureless-glueless-flapless scleral fixated intraocular lens (IOL). Methods: Prospective study of 86 eyes of 74 patients who underwent sutureless, glueless, and flapless scleral fixated IOL from June 2016 to March 2019. All patients underwent standard scleral fixated IOL without sutures or glue. Pre-operative best-corrected visual acuity(BCVA) and intraocular pressure was assessed. Horizontal corneal white to white (hWTW) diameter and axial length (AL) were assessed. All patients were followed up on day 1, 1 month, 3 months, and 6 months. All patients had a minimum follow-up of 6 months. Post-operative BCVA, intraocular pressure, IOL centration, and IOL-related complications were noted including tilt, decentration, dislocation, haptic extrusion, and optic capture. Results: Mean age was 66 ± 13.4 years. Eighty-six eyes of 74 patients with aphakia, subluxated IOL, and subluxated crystalline lens were included in the study. The mean pre-operative BCVA was 1.21 ± 2.8 (Log MAR). The mean post-operative BCVA at 6 months was 0.34 ± 0.21 (Log MAR). Significant improvement in mean BCVA was noted at 6 months after the procedure(P=0.011). From the final analysis, 10 eyes were excluded for insufficient follow-up, missing data, or concomitant surgery. There were six eyes excluded for technique modification and two eyes for isolated haptic erosion from the scleral tunnel without lens malposition. From our final analysis of 68 eyes, 8 eyes (12%) developed complications of the IOL. Of these, 3 (38%) eyes underwent surgical intervention. Patients with large hWTW experienced significantly higher rate of complications (P = 0.04). Longer AL was not predictive of higher complication rate (P = 0.08). Conclusions: Suture or glue is not an absolute must for scleral fixation of an IOL. Sutureless, glueless, and flapless scleral fixation of IOL is a safe surgical option in eyes without capsular support with fewer complications, stable IOL, reduced surgical time, shorter learning curve, good refractive outcome, and without any suture or glue-related complications.