**Conflict of interest**

*Intraocular Lens*

patients.

cause it.

fixation IOL [13].

**4. Conclusions**

ence the overall visual prognosis.

short-term follow-up.

**Acknowledgements**

Not applicable. No funding.

*3.5.4 Advantages of scleral-fixated IOLs*

One major advantage of scleral-fixated IOL, especially for a vitreoretinal surgeon, is that any future vitreoretinal surgery procedure can be performed with no risk of IOL dislocation, as may happen in anterior placed IOLs [12]. Moreover, these complicated cases in which secondary IOLs are indicated are at risk to develop posterior segment complications that require proper examination and even surgical treatment. Pupil dilatation and examination of the retina and vitreous are much easier in an eye with scleral-fixated IOL than in one with ACIOL or iris-fixated IOL [12]. Besides, PPV which is usually performed before suturing IOL at the sclera considerably decreases the risk of future posterior segment complications in these

In all our cases, prior to suturing IOL at the sclera, PPV has been performed. This contributed to visual function improvement by eliminating all the debris, blood, and inflammatory cells from the vitreous cavity which are specific for the

Scleral-fixated IOL should be the preferred technique to correct aphakia also because it is more physiological than anterior segment IOL placement, which may be associated with the risk of corneal touch and loss of endothelium, anterior uveitis, and glaucoma in the long run [5]. Chronic glaucoma requiring long-term topical treatment was diagnosed in three patients in our series (5.26%), all in the trauma group, which allows us to speculate that posttraumatic injuries, rather than the surgical technique itself, were more likely to

Some surgeons advocate that in experienced hands, fixating an IOL to the sclera offers a visual prognosis which is good enough to favor this procedure as the standard of care for correcting aphakia in patients with insufficient capsular support [12]. With its limitations and lack of long-term follow-up, our study supports this idea. Larger sample and longer-term follow-up are necessary to establish the safety and complications associated with scleral-fixated IOLs. Also, there is room for innovating IOL designs and surgical techniques, like sutureless glueless scleral

Ab interno scleral fixation of a rigid IOL was a safe and viable technique to cor-

During surgery, the most frequent complication was mild vitreous hemorrhage

The complications noted in the postoperative period were few and did not influ-

The limitations of this study are the relatively small sample of patients and the

Studies on higher number of patients and with longer follow-up are mandatory in order to outline the status of scleral-fixated IOL as the standard of care for cor-

rect aphakia in patients with inappropriate capsular support in this series.

which was self-limiting and did not prevent the recovery of visual acuity.

recting aphakia in patients with insufficient capsular support.

posttraumatic and complicated postcataract surgery settings [12].

**144**

The author declares no conflict of interest related to the publication of this paper.
