Scleral-Fixated Intraocular Lens

Mr Robert Henderson BSc MBBS MD FRCOphth · Consultant Vitreoretinal Surgeon, Moorfields Eye Hospital & GOSH

Problems after cataract surgery or a displaced lens implant can leave you uncertain about what comes next. Mr Henderson reviews your previous treatment and the support available inside your eye, then explains whether repositioning or replacing a lens implant may help.

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At a Glance

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TechniquesCarlevale IOL or Gore-Tex sutured AKREOS

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AnaestheticLocal or general

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OutcomeStable, long-term solution

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LocationMoorfields Eye Hospital

The Problem

When Standard Lens Fixation is Not Possible

A standard intraocular lens implant relies on the lens capsule — the thin bag left behind after cataract surgery — to hold it securely in the correct position. When this capsule is absent, damaged, or insufficiently supported by its zonular attachments, the lens cannot be placed safely in the normal position and an alternative approach is required.

Scleral fixation solves this problem by anchoring the lens directly to the sclera (the white wall of the eye), bypassing the capsule entirely. The technique chosen depends on the specific clinical situation, and in particular whether the patient has normal connective tissue or a condition such as Marfan syndrome that affects the scleral wall.

Two Techniques

Choosing the Right Approach

For patients with normal sclera

Carlevale IOL

The Carlevale is a purpose-designed scleral-fixated lens implant with self-retaining flanged haptics that anchor securely within intrascleral tunnels without the need for sutures.

This sutureless technique is highly stable and reproducible. The lens sits in an excellent centred position and provides outstanding long-term stability with a low risk of late dislocation.

Mr Henderson’s preferred technique for the majority of patients requiring secondary IOL implantation or IOL exchange in the setting of normal scleral tissue.

For patients with connective tissue disorders

Gore-Tex Sutured AKREOS ADAPT AO — 4-point fixation

In patients with connective tissue conditions such as Marfan syndrome, the scleral tissue may not provide sufficient resistance for flanged haptic fixation. In these cases, Mr Henderson uses the AKREOS ADAPT AO lens with four-point scleral fixation using Gore-Tex (CV-8) sutures.

Four-point fixation distributes load across four scleral sites, providing exceptional rotational stability and resistance to dislocation even in compromised sclera.

Gore-Tex sutures are non-absorbable and have specific benefits and potential complications that will be discussed during surgical planning.

Who Needs This?

Indications for Scleral Fixation

Absent or insufficient lens capsule after cataract surgery

Dislocated or subluxated IOL

Traumatic lens dislocation

Ectopia lentis (e.g. Marfan syndrome)

Failed previous cataract surgery

Severe zonular weakness or dehiscence

Aphakia following vitreoretinal surgery

Congenital lens abnormalities in adults

“Choosing between these two techniques comes down to the quality of the scleral tissue. For patients with connective tissue disease, four-point suture fixation with Gore-Tex may provide a suitable alternative to flanged haptic fixation.”

Paediatric Considerations

Children and Young Patients

In very young children with conditions such as ectopia lentis, Mr Henderson takes a cautious approach to scleral-fixated IOL implantation. The small size of a young child’s eye, the softness of the sclera, and the ongoing growth of the eye during childhood mean that surgical intervention carries specific risks at this age that are not present in older patients.

For young children, the preferred approach is optical rehabilitation with a well-fitted contact lens service, which provides excellent visual outcomes without the risks of intraocular surgery in a developing eye. Scleral fixation is considered as the child grows older and the eye approaches adult dimensions, typically in the teenage years or later, at which point either the Carlevale or Gore-Tex sutured technique can be offered depending on the underlying condition.

Questions & Answers

Frequently Asked Questions

What to expect

Your Journey from Assessment to Recovery

Specialist Assessment

Full examination of the anterior and posterior segment to assess suitability. Previous surgical records are reviewed to understand the specific anatomy and surgical history.

Surgical Planning

Mr Henderson selects the most appropriate lens and fixation technique for your specific situation — including combined vitreoretinal procedures where required.

Surgery at Moorfields

Complex surgery performed personally by Mr Henderson in the specialist vitreoretinal theatres at Moorfields Eye Hospital. Most patients are discharged the same day.

Recovery & Refraction

Vision stabilises over several weeks. Final spectacle correction is refined once the eye has settled. Mr Henderson follows your recovery personally throughout.

How do you decide which technique to use?

The primary consideration is the quality of the scleral tissue. In patients with normal connective tissue, the Carlevale IOL with flanged haptic fixation is the preferred technique — it is elegant, sutureless, and provides excellent long-term stability. In patients with connective tissue disorders such as Marfan syndrome, the AKREOS ADAPT AO lens with four-point Gore-Tex fixation is used, as this provides greater security in tissue that may not hold a flanged haptic reliably over time.

My IOL has dropped into the back of the eye — what happens now?

A dislocated IOL that has fallen into the vitreous cavity requires vitrectomy surgery to retrieve it safely. At the same procedure, the lens is either repositioned using scleral fixation or exchanged for a new IOL. The technique used depends on the condition of the existing lens, the state of the capsule, and the patient’s scleral tissue. This is a well-recognised situation managed routinely by experienced vitreoretinal surgeons.

Will I need glasses after scleral-fixated IOL surgery?

The IOL power is selected to target good unaided distance vision in most cases. Fine-tuning with spectacles for near or intermediate tasks may still be needed. The visual outcome is generally very good, and most patients are delighted after what is often a prolonged period of severely impaired vision without a functional lens implant.

My child has Marfan syndrome and dislocated lenses — when should surgery be considered?

In young children, the preference is to manage aphakia or high refractive error with contact lenses, which achieves excellent visual rehabilitation without intraocular surgery. Scleral-fixated IOL implantation is considered as the child grows older and the eye approaches adult size, at which point four-point Gore-Tex fixation with the AKREOS ADAPT AO lens provides a secure and durable long-term solution. Each case is assessed individually, and the timing of surgery is decided in discussion with the family and the multidisciplinary team.

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Making a decision about surgery

Your consultation will cover the potential benefits, the risks of complications, alternatives and the recovery involved. The likely result depends on your diagnosis, the health of your eye and any previous treatment. An assessment does not commit you to an operation.

Arrange a Consultation

Discuss your symptoms, ask questions and understand your options before deciding on treatment.

To arrange an assessment for scleral-fixated IOL surgery, please contact Alison Anscombe, Mr Henderson’s secretary:

07762 112552 · moorfields.rhenderson@nhs.net

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. He holds an Honorary Associate Professorship at UCL-GOSH Institute of Child Health.