Modified Two-Point Scleral Fixation of a Four-Haptic Intraocular Lens with Cerclage Pupilloplasty

Abstract

Aphakia in the absence of adequate capsular or zonular support remains one of the most demanding challenges in anterior segment surgery. The condition may arise secondary to trauma, hereditary connective tissue disorders such as Marfan syndrome, complicated cataract surgery, or long-term pseudophakia with in-the-bag intraocular lens (IOL) dislocation. Our study describes outcomes of a modified two-point Canabrava scleral fixation technique, using 6-0 polypropylene sutures, combined with cerclage pupilloplasty for anterior segment reconstruction in eyes with zonular and iris damage. In our study, eight eyes have been treated with modified two-point scleral fixation between 2021 and 2025. The treatment involves external docking of the suture, elimination of intraocular docking combined with cerclage pupilloplasty, where it is indicated. Mean preoperative best-corrected visual acuity is 0.05 ± 0.04, improved to 0.80 ± 0.14 at 1 month. Mean intraocular pressure decreased from 21.0 ± 8.7 mmHg to 14.3 ± 1.2 mmHg. All IOLs remained well-centered, pupils were round and reactive, and no intraoperative/postoperative complications occurred. The main limitation of this case series is the retrospective design and limited sample size of eight cases using the modified technique. A larger, prospective comparative study with long-term follow-up is needed to confirm these preliminary results and to assess potential late flange degradation or suture-related changes beyond 2–3 years. This modification simplifies scleral fixation by externalizing the docking step, offering a safe, minimally invasive method in complex eyes with absent capsular support.

Received: 5 November 2025 | Revised: 24 December 2025 | Accepted: 7 January 2026

Conflicts of Interest

Migena Beqiri and Klea Bojaxhi are employees of the Albanian Eye Centre. The authors declare that they have no conflicts of interest to this work.

Data Availability Statement

The data that support the findings of this study are openly available in the Albanian Eye Centre at www.unitir.edu.al.

Author Contribution Statement

Ali Tonuzi: Conceptualization, Validation, Writing – review & editing, Project administration. Orjeta Tonuzi: Conceptualization, Investigation. Migena Beqiri: Methodology, Formal analysis, Writing – original draft, Visualization. Klea Bojaxhi: Conceptualization, Investigation. Luan Qafmolla: Methodology, Software, Validation, Data curation, Writing – original draft, Writing – review & editing, Visualization.