A Novel Intraocular Lens and Capsular Bag Complex Suspension Technique for Repositioning Late In-the-Bag Intraocular Lens Dislocation

Purpose: To present a novel in situ scleral suspension surgical technique for the management of dislocated intraocular lens (IOL)-capsular bag complex and to evaluate its clinical efficacy. Patients and Methods: Patients who underwent the novel in situ scleral suspension technique for in-the-bag IOL dislocation at the Department of Ophthalmology, Shanghai General Hospital, between February 2024 and February 2025, were included. The technique involves performing a scleral puncture 3 mm posterior to the limbus, passing a single suspensory suture twice through the fibrotic capsular tissue of the dislocated IOL-capsular bag complex, and securing the suture to the sclera with a single knot. Preoperative and postoperative uncorrected distance visual acuity (UDVA) and best-corrected visual acuity (BCVA), as well as adverse events, were recorded. Results: A total of 8 eyes from 8 patients were included. The median preoperative uncorrected distance visual acuity (UDVA), expressed as the logarithm of the minimum angle of resolution (logMAR), was 1.3 (range, 1.0– 2.0), improving to 0.56 (range, 0– 2.3) at the final follow-up. During the postoperative follow-up period (1 month to 1 year), transient ocular hypertension and uveitis occurred in one patient each, with no other significant adverse events observed, including IOL tilt, decentration, pupillary capture, suture exposure, or vision-threatening macular edema. Conclusion: This novel in situ suspension technique for in-the-bag IOL dislocation demonstrates enhanced postoperative uncorrected distance visual acuity, a favourable short-term safety profile, simplified procedural steps with minimally tissue trauma, independence from the type of dislocated IOL, and no requirement for specialized instruments or bio-materials. Future studies with extended follow-up are warranted to validate its long-term efficacy and safety. Keywords: intraocular lens dislocation, scleral fixation, suspension technique, in situ scleral suspension