To describe a novel technique for toric intraocular lens (IOL) repositioning and fixation in the absence of adequate capsular support

Case report and literature review

Two cases are presented with scleral fixation of a one-piece toric IOL (SN6AT series, Alcon Inc.) In both cases, toric IOLs initially placed within the capsular bag became decentered due to poor capsular support and/or posterior capsule rupture. To avoid the potential complications of lens explantation and maintain the astigmatic benefits of the toric IOL, scleral fixation of the lenses was performed. The Hoffman technique was used to create reverse scleral pockets without conjunctival dissection. A 10-0 suture was used to capture and then secure the lens haptics in a lasso-type fashion. Sutures were then buried within the previously created scleral pockets. Both patients had well centered lenses postoperatively and have remained stable at last follow-up, up to thirty months postoperatively.

In the absence of adequate capsular support, scleral fixation is a viable option for one-piece toric IOL fixation to avoid IOL explanation