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

Abstract

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.