Long-Term Surgical Outcomes of Scleral Flap versus Scleral Pocket Technique for Sutureless Intrascleral One-Piece Lens Fixation

Objectives: This study compared long-term surgical outcomes of the scleral flap versus scleral pocket technique for sutureless intrascleral one-piece intraocular lens (IOL) fixation. Methods: A retrospective comparative study was conducted at a single center, involving consecutive patients undergoing sutureless intrascleral one-piece IOL implantation, between January 2020 and May 2022. Eyes were divided into two groups based on the surgical technique: group 1 underwent scleral flap (n = 64), and group 2 received scleral pocket technique (n = 59). Visual acuity, refractive outcomes, and complications were assessed over a minimum 24-month follow-up period. Results: Both groups showed improvements in best-corrected visual acuity (BCVA), increasing from 0.84 +/- 0.56 logMAR at baseline to 0.39 +/- 0.23 logMAR (p = 0.042) at 24 months in group 1 and from 0.91 +/- 0.63 logMAR at baseline to 0.45 +/- 0.38 logMAR (p = 0.039) at 24 months in group 2. No significant differences in BCVA were observed between the groups at baseline (p = 0.991), 12 (p = 0.496) and 24 months (p = 0.557). Mean spherical equivalent (-0.73 +/- 1.32 D in group 1 and -0.92 +/- 0.99 D in group 2, p = 0.447), refractive prediction error (-0.21 +/- 1.1 D in group 1 and -0.35 +/- 1.8 D in group 2, p = 0.377), and surgically induced astigmatism (0.74 +/- 0.89 D in group 1 and 0.85 +/- 0.76 in group 2, p = 0.651) were comparable between the two groups. An IOL tilt of 5.5 +/- 1.8 and 5.8 +/- 2.0 degrees (p = 0.867) and an IOL decentration of 0.41 +/- 0.21 mm and 0.29 +/- 0.11 mm (p = 0.955) were obtained, respectively, in group 1 and group 2 at 24 months. Mean endothelial cell density remained stable at 24 months in both groups (p = 0.832 in group 1 and p = 0.443 in group 2), and it was 1747.20 +/- 588.03 cells/mm2 in group 1 and 1883.71 +/- 621.29 cells/mm2 in group 2 (p = 0.327) at baseline, 1545.36 +/- 442.3 cells/mm2 in group 1 and 1417.44 +/- 623.40 cells/mm2 in group 2 (p = 0.483) at 24 months. No cases of endophthalmitis were observed. Conclusions: The scleral pocket technique for sutureless intrascleral one-piece IOL fixation is comparable to the traditional scleral flap technique in terms of long-term visual outcomes and safety. The scleral pocket technique offers a simplified approach and a viable option even for less experienced surgeons.