Scleral-Fixated Intraocular Lens
Why Is Scleral Fixation Sometimes Necessary?
In routine cataract surgery, the artificial intraocular lens (IOL) sits within the natural lens capsule, which acts as a supporting bag. When this capsular support is absent, compromised, or unstable, the lens cannot be safely positioned in its usual location. Scleral fixation anchors the lens directly to the wall of the eye (the sclera), bypassing the need for capsular support entirely.
Situations where scleral fixation may be required include:
- Aphakia following complicated cataract surgery — where the capsule was torn or insufficient to support a standard IOL
- Subluxated or dislocated IOL — when a previously implanted lens has shifted out of position, whether from zonular weakness, trauma, or pseudoexfoliation syndrome
- Subluxated crystalline lens — particularly in connective tissue conditions such as Marfan syndrome or Weill–Marchesani syndrome
- Trauma — including lens dislocation or capsular rupture following ocular injury
- Failed primary cataract surgery — where no adequate capsular remnant remains
- Ectopia lentis — congenital or acquired lens displacement
Surgical Approaches
Two principal techniques are used in my practice, chosen according to the patient’s anatomy, the type of lens being implanted, and the clinical context. Both produce excellent, stable, long-term outcomes in the right hands.
Carlevale IOL — Intrascleral Haptic Fixation
The Carlevale IOL (Soleko) is a dedicated single-piece lens designed specifically for sutureless intrascleral fixation. The lens has specially designed haptics that are externalised through small scleral incisions and anchored within the scleral tissue itself, without the need for sutures. A flanged or plug-like haptic tip sits securely within a scleral tunnel, fixing the lens in a stable, centred position.
The key advantages of this approach are its sutureless nature — eliminating any risk of suture-related complications over time — and the excellent centration and stability the lens achieves. The Carlevale is my preferred approach for straightforward cases of secondary IOL implantation where good scleral tissue is available. The operation is typically performed through small, well-tolerated incisions, and recovery is generally smooth.
Gore-Tex Suture Fixation (CV-8)
Gore-Tex suture fixation uses a fine expanded polytetrafluoroethylene (ePTFE) suture — Gore-Tex CV-8 — to secure a three-piece IOL (such as the Akreos AO60) to the scleral wall. A double-needle Gore-Tex suture is passed through the sclera and used to anchor the lens haptics, providing stable, long-term fixation.
Gore-Tex has become the preferred suture material for this technique because of its extraordinary durability — unlike polypropylene (Prolene) sutures, which can degrade and snap years after surgery, Gore-Tex maintains its structural integrity indefinitely. The Akreos AO60 lens is well suited to this approach, as its four-point haptic design allows secure fixation with excellent positional stability and a low risk of lens tilt.
This technique is particularly useful in cases where scleral tissue quality precludes purely intrascleral haptic fixation, or in complex re-operative situations where the surgical anatomy demands a suture-based approach.
Choosing Between Techniques
The choice between Carlevale intrascleral fixation and Gore-Tex suture fixation is made on a case-by-case basis following careful preoperative assessment. Factors that influence the decision include the quality and thickness of the sclera, the degree of vitreous involvement requiring concurrent vitrectomy, the presence of concurrent pathology, and whether the procedure is a primary implantation or a revision of a previous repair.
In practice, both techniques produce excellent long-term outcomes. The sutureless Carlevale approach offers a slightly simpler surgical workflow in straightforward cases, while Gore-Tex fixation offers additional versatility and reliability in more complex or re-operative situations. I will discuss the most appropriate approach with you at your consultation, with a clear explanation of the reasoning and what to expect.
Combined Surgery
Scleral-fixated IOL implantation is frequently combined with pars plana vitrectomy (PPV), particularly when a dislocated lens or IOL has fallen into the vitreous cavity, or where concurrent retinal pathology requires treatment. As a vitreoretinal surgeon, I am well placed to manage both components of these complex combined procedures — removing the dislocated lens, treating any associated retinal pathology, and implanting a securely fixated secondary IOL in a single operative episode. This combined approach minimises the number of procedures required and reduces overall surgical risk.
What to Expect: The Procedure
Anaesthesia
Scleral-fixated IOL surgery is most commonly performed under local anaesthesia with intravenous sedation, which allows you to be relaxed and comfortable throughout. General anaesthesia is available for patients who prefer it or where clinical circumstances require it.
During the Operation
The procedure typically takes between 60 and 90 minutes, depending on complexity. Where a dislocated lens is being retrieved from the vitreous, a vitrectomy is performed first. The scleral-fixated lens is then positioned and secured using the chosen technique. Small conjunctival and scleral incisions are sutured closed at the end of the procedure.
After Surgery
Following scleral-fixated IOL surgery, most patients experience a significant improvement in vision as the eye recovers. A postoperative drops regimen will be prescribed. You will be reviewed at regular intervals in the weeks following surgery to ensure the lens is well positioned and the eye is healing as expected.
The long-term stability of modern scleral fixation techniques — particularly with Gore-Tex suture material and the Carlevale design — is excellent. Unlike older polypropylene suture techniques, which carried a well-recognised risk of late suture degradation and lens dislocation, contemporary approaches are designed to provide lifelong security.
Risks and Complications
Scleral-fixated IOL surgery is a complex procedure, and the risks are somewhat higher than those of routine primary cataract surgery. Potential complications include:
- Raised intraocular pressure
- Lens tilt or decentration (usually mild and well tolerated)
- Hypotony (low pressure) — usually transient
- Vitreous haemorrhage
- Retinal detachment — particularly relevant in high myopes or in cases involving vitreoretinal surgery
- Cystoid macular oedema (CMO) — responsive to treatment in the majority of cases
- Infection (endophthalmitis) — rare but serious
These risks will be discussed with you in detail at your consultation. For most patients with a dislocated IOL or aphakia, the visual and functional benefits of scleral fixation substantially outweigh the risks of leaving the eye without a properly positioned lens.
Private Scleral-Fixated IOL Surgery in London
Private scleral-fixated IOL surgery is available at 1 Welbeck, Marylebone (opening September 2026), offering a central London location with the same surgical standards as the specialist NHS centre. Consultations are currently available at Moorfields Eye Hospital.
If you have been told that you have a dislocated intraocular lens, are aphakic following previous eye surgery, or have been referred for secondary lens implantation, please contact Alison Anscombe, my personal secretary, to arrange an assessment.
Book a Consultation
To discuss scleral-fixated IOL surgery or any complex lens problem, please contact my secretary Alison Anscombe:
📞 +44 7974 015691 | 📧 [email protected]
Or use the contact form on this website.
Mr Robert Henderson BSc MBBS MD FRCOphth is a Consultant Vitreoretinal Surgeon at Moorfields Eye Hospital and Great Ormond Street Hospital, and Clinical Lead for Ophthalmology at GOSH.