American Journal of Ophthalmology Case Reports · Published 2026-05-05 · DOI 10.1016/j.ajoc.2026.102596
Purpose: Intraocular lens (IOL) implantation in cases of insufficient capsular support remains challenging. This study introduces a modified belt loop technique (BLT) for scleral fixation of IOLs in eyes with insufficient capsular support, utilizing long, limbus-parallel scleral tunnels to improve stability and safety. Methods: This case series included patients who underwent IOL scleral fixation with the modified BLT at a single center. The technique employed a 7-0 polypropylene suture passed through eyeleted or fenestrated haptics, with flanges created by thermocautery and secured within scleral tunnels oriented parallel to the limbus. Outcome measures included visual acuity, spherical equivalent, intraocular pressure, endothelial cell density, IOL tilt and decentration, and complications. Minimum follow-up was 3 months. Results: This technique was successfully applied in 32 eyes of 32 patients (mean age 55.03 ± 12.83 years; 24 males). Mean follow-up was 6.35 ± 1.96 months (range 3–10 months). Best-corrected visual acuity improved from 0.51 ± 0.63 logMAR preoperatively to 0.31 ± 0.39 logMAR at final follow-up (P < 0.05). No significant change in intraocular pressure (IOP) was observed throughout follow-up (preoperative 16.06 ± 2.16 mmHg vs. final 15.37 ± 3.34 mmHg; P > 0.05). Endothelial cell loss was 8.83% ± 10.03% at final follow-up. Regarding IOL position, mean vertical and horizontal tilt angles were 2.23 ± 1.09° and 2.11 ± 1.02°, respectively; mean decentration values were 0.29 ± 0.18 mm vertically and 0.21 ± 0.09 mm horizontally. Except for transient mild intraoperative bleeding (n = 2, 6.25%) and transient postoperative intraocular pressure elevation (n = 3, 9.38%), no other complications or clinically significant IOL tilt or decentration were observed during follow-up. Conclusions: The modified belt loop technique is a safe and effective method for IOL fixation. It provides stable four-point fixation, minimizes risks of flange extrusion and disinsertion, and is applicable to various IOL designs with eyeleted or fenestrated haptics.
Abstract from DOAJ. Public domain (CC0 1.0).
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