Modified 3-piece intraocular lens of iris fixation technique in the management of cases without capsular support: Sutureless iris fixation (Dağ technique)

To describe a sutureless technique for iris fixation of a 3-piece intraocular lens (3P-IOL) in the anterior chamber in eyes without capsular support, and to evaluate its outcomes. Twelve patients (10 aphakic, 2 with 3P-IOL subluxation post-Yamane technique) underwent detailed ophthalmologic evaluation. In required cases, anterior vitrectomy and 0.01% carbachol (Miostat, Alcon Laboratories, Fort Worth, TX, USA) were used to achieve miosis. Two mid-peripheral iridectomies were created with a vitrectomy probe. After viscoelastic injection, a 3P-IOL (SENSAR, Johnson and Johnson Vision, USA) was inserted into the anterior chamber using a cartridge. Haptics were positioned behind the iris through the iridectomy sites using microforceps. In subluxated intraocular lens (IOL) cases, the lens was repositioned similarly. Best corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), and corneal endothelial density (CED) were recorded preoperatively, at 1 month, and at the final visit. The cohort included eight males and four females (mean age: 71.08 ± 4.07 years). Postoperative BCVA improved significantly (P < 0.001). No significant differences were found in IOP, CMT, or CED (P > 0.05). One case of transient IOP elevation was managed medically. Over a mean follow-up of 20.9 ± 4.8 months, no complications such as pigment dispersion, uveitis, hemorrhage, IOL decentration, macular edema, or corneal decompensation occurred. Iris fixation of a 3-piece IOL without sutures is a fast and effective technique that has demonstrated favorable short-term safety in patients without capsular support, provided that adequate anterior chamber depth and endothelial health are present.