Modified sutureless flanged intrascleral intraocular lens fixation in pediatric patients: clinical outcomes over 2 years of follow-up.

PURPOSE: To evaluate the visual and anatomical outcomes of modified sutureless flanged intrascleral intraocular lens (IOL) fixation in pediatric patients with insufficient capsular or zonular support. METHODS: This retrospective case series included pediatric patients (≤ 18 years) who underwent flanged intrascleral IOL fixation between January 2022 and August 2023 at Beijing Tongren Hospital, with a minimum follow-up of two years of follow-up. All patients underwent a comprehensive ophthalmic examination. IOL tilt and decentration were automatically measured using swept-source anterior segment optical coherence tomography, and haptic intrascleral visibility was graded as none or invisible (Grade 0), mild or slight (Grade I), and moderate or obvious (Grade II). RESULTS: Fifteen eyes from 11 patients (mean age, 11.5 ± 4.1 years) were included, with a mean follow-up of 29.0 ± 4.4 months. At the final visit, the mean best-corrected visual acuity (BCVA) improved from 0.75 ± 0.57 to 0.21 ± 0.18 logMAR (t = 3.867, P = 0.002). Mean IOL tilt and decentration were 3.99 ± 2.50° and 0.35 ± 0.35 mm, respectively. Haptic visibility was graded as Grade 0 in 13.6%, Grade I in 72.7%, and Grade II in 13.6%. No cases required IOL repositioning. CONCLUSIONS: Sutureless flanged intrascleral IOL fixation demonstrated favorable visual outcomes and stable IOL positioning in pediatric patients. Systematic grading of haptic intrascleral visibility provided additional information regarding postoperative haptic embedding. This technique provides a safe and effective alternative to sutured fixation for secondary IOL implantation in children.