Sutureless Scleral Fixated Intraocular Lens Implantation Techniques: Evolution, Innovations, and Outcomes

Scleral fixation of intraocular lenses (SFIOL) was developed to address IOL implantation in aphakic eyes without capsular support. Leaving permanent sutures in the sclera poses long-term risks such as suture erosion or damage; thus, sutureless techniques have been developed. This article provides a comprehensive overview of multiple sutureless scleral fixation techniques for IOL implantation, discussing strengths, weaknesses, and clinical outcomes, as well as complications. This article covers the scleral tuck, fibrin glue-assisted method, Yamane flanged-haptic technique, the Carlevale self-anchoring lens, and the emerging 5F technique. Metrics such as visual acuity, refractive stability, operative time, and complications such as IOL tilt, subluxation, and macular pathologies are discussed. This review also guides on technique selection individualized to patient factors and surgeon expertise and best practices to optimize visual and surgical outcomes. Sutureless SFIOL is an effective and safe alternative to sutured SFIOL with favorable visual outcomes and operating time efficiency profiles when appropriately selected and executed.