Clinical outcomes of a novel intrascleral intraocular lens fixation method: the direct-needle technique using a double-needle approach

The flanged double-needle technique is widely used for intrascleral intraocular lens (IOL) fixation in eyes lacking capsular support; however, it carries the risk of the IOL dropping into the vitreous cavity and can be technically demanding. We describe a modified approach, the “direct-needle technique,” and report its clinical outcomes. This retrospective observational study analyzed 99 eyes of 99 patients who underwent intrascleral IOL fixation using the direct-needle technique at Showa University Fujigaoka Hospital between August 2019 and July 2023. Surgical indications included IOL dislocation ( n = 68), lens subluxation ( n = 25), and aphakia ( n = 6). An Eternity Fine Natural IOL (Model Nx-70 S), which features polyvinylidene fluoride (PVDF) haptics, and an Eternity Access Ease injector (Model SXJ-70IIS) were used in all cases. No intraoperative complications, such as IOL dropping into the vitreous cavity or iris damage, occurred during the procedure. Postoperatively, temporarily high intraocular pressure (IOP > 21 mmHg) developed in nine eyes, low IOP (IOP < 10 mmHg) in eight eyes, IOL capture in two eyes, bullous keratopathy in two eyes, and retinal detachment in one eye. Visual acuity improved in 53 eyes, remained unchanged in 38 eyes, and worsened in five eyes. The mean corneal endothelial cell loss was 9.7% ± 20.9%. The direct-needle technique is a method that may enhance the safety of intrascleral IOL fixation by reducing the risk of intraoperative IOL dislocation into the vitreous cavity and iris injury.