A novel method for managing advanced zonular dialysis: Sclerocorneal flanged monofixation of intraocular lens and capsular bag complex

Abstract

Purpose

To evaluate the visual, refractive, and anatomical outcomes, as well as the early safety and stability of the sclerocorneal flanged monofixation technique in eyes with advanced zonular dialysis undergoing cataract extraction.

Methods

This retrospective interventional case series included 22 eyes of 17 patients who underwent phacoemulsification and in-the-bag IOL implantation using the Telegin sclerocorneal flanged monofixation technique between January 2022 and June 2023. Postoperative evaluations included best-corrected visual acuity (BCVA), intraocular pressure (IOP), Scheimpflug-based analysis of IOL tilt and decentration, anterior segment optical coherence tomography (AS-OCT) assessment of flange depth, and endothelial cell density (ECD) measurement by specular microscopy. Supplementary Video 1 demonstrates the surgical steps.

Results

The mean age was 62.4 ± 4.7 years. BCVA improved significantly from 0.27 ± 0.19 preoperatively to 0.83 ± 0.32 at 6 months (p < 0.001), with no significant change in IOP (p = 0.764). The mean IOL tilt was 0.7 ± 0.3°, mean decentration 0.11 ± 0.06 mm, and mean flange depth 225 ± 40 µm. The mean pre- and postoperative ECD values were 2,374 ± 423 and 2,356 ± 390 cells/mm², respectively (p = 0.18). No intraoperative or postoperative complications occurred, and only one patient (4.5%) reported transient dysphotopsia that resolved by 3 months.

Conclusion

The sclerocorneal flanged monofixation technique offers excellent early IOL stability, minimal endothelial cell loss, and high visual performance in eyes with zonular dialysis. Its simplicity, reproducibility, and lack of suture-related complications make it a promising, cost-effective alternative to traditional modified capsular tension ring or double-flanged haptic techniques.

Keywords

Sclerocorneal monofixation subluxated crystalline lens capsular tension ring decentration

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