Effect of Haptic Design, Passing Direction, and Inter-Flange Distance on the Position of the Intraocular Lens during 4-Flanged Intrascleral Fixation.

Purpose: We aimed to investigate the effect of haptic design, direction of suture passage, and distance between flanges on the haptic-iris distance after four-flanged scleral fixation of a single-piece intraocular lens with four eyelets.

Methods: After marking the 3 and 9 o'clock positions on the limbus, each 26-G needle was positioned 2.0 mm posterior to the limbus and passed 2.0, 3.0, and 4.0 mm away from the markings at 3 o'clock and 9 o'clock, respectively. We passed each end of a 5-0 polypropylene suture anteroposteriorly or posteroanteriorly through two unilateral eyelets. The haptic-iris distance was evaluated using anterior-segment optical coherence tomography.

Results: Passing the suture through the eyelets in the posteroanterior direction yielded a wider haptic-iris distance than that achieved by passing the suture in the anteroposterior direction (p < 0.001, respectively). A wider distance between the polypropylene flanges correlated with reduced distortion of haptic structures. Fixation of the Akreos AO with a 4.0-mm suture spacing induced a wider haptic-iris distance (p < 0.001).

Conclusion: Passing sutures through the eyelet in the posteroanterior direction during intrascleral fixation proved to be more effective in securing a sufficient haptic-iris distance. A wider distance between flanges was beneficial in preventing structural distortion of the haptic and ensuring a proper distance between the haptic and iris.