Needle-Guided Scleral Fixation: A New Single-Suture Approach

Q: For which patients is needle-guided scleral fixation intended?

It is intended for aphakia and eyes with inadequate capsular support, where posterior chamber IOL placement is anatomically desirable.

Q: How does the needle-guided single-suture technique work?

A 24-gauge needle guides a double-armed 10-0 polypropylene suture through the sclera for precise IOL anchorage, minimizing vitreous manipulation.

Q: What were the key safety outcomes at 24 months?

All IOLs remained well-centered, and no suture erosion, vitreous hemorrhage, or retinal detachment was observed over the 24-month follow-up period.

Sep 30, 2026

Uploaded by Mary Man

Scleral fixation of intraocular lenses (IOLs) is a key option for aphakia or inadequate capsular support, but conventional sutured and sutureless strategies can create technical difficulty and complication risk. A retrospective interventional case series evaluated Meduri’s needle-guided single-suture method in 30 eyes using a 24-gauge needle to guide a double-armed 10-0 polypropylene suture, with outcomes assessed over 24 months. Results showed improved visual acuity, stable IOL centration, and no suture erosion, vitreous hemorrhage, or retinal detachment, supporting safety and reproducibility.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Introduction

Background and clinical rationale

Evolution of scleral fixation techniques

Rationale for the needle-guided single-suture approach

Methods and outcomes

Surgical technique

Follow-up and outcome measures

Results and conclusions

Article Needle-Guided Scleral Fixation: A New Single-Suture Approach Laura De Luca 1, Giovanni William Oliverio 1, Maura Mancini 1, Rino Frisina 2, Feliciana Menna 3, *, Stefano Lupo 3, Pierluigi Grenga 4, Cosimo Mazzotta 5, Pasquale Aragona 1 and Alessandro Meduri 1 Academic Editor: Kazutaka Kamiya Received: 2 October 2025 Revised: 13 November 2025 Accepted: 8 December 2025 Published: 22 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Ophthalmology Clinic, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy; [laura.deluca21@gmail.com](laura.deluca21@gmail.com) (L.D.L.); [gioliverio@unime.it](gioliverio@unime.it) (G.W.O.) 2 Ophthalmology Unit, Surgery Department, Piacenza Hospital, 29121 Piacenza, Italy; [frisinarino@gmail.com](frisinarino@gmail.com) [3](3 Department of Medical-Surgical Sciences and Biotechnologies)[ Department of Medical-Surgical Sciences and Biotechnologies](3 Department of Medical-Surgical Sciences and Biotechnologies), [U.O.C](U.O.C). Ophthalmology, Sapienza University of Rome, Via Firenze 1, 04019 Terracina, Italy 4 Ophthalmology Unit UOC, ASL Roma 3 G.B. Grassi Hospital, Ostia Lido, 00122 Rome, Italy 5 Faculty of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy * Correspondence: [feliciana.menna@gmail.com](feliciana.menna@gmail.com); Tel.: +39-3484515359 Abstract Background: Scleral fixation of intraocular lenses (IOLs) is a valuable option in cases of aphakia or inadequate capsular support, yet conventional sutured and sutureless approaches can pose technical challenges and complication risks. The needle-guided scleral fixation technique offers a simplified, single-suture solution that enhances safety and reproducibility. Methods: In this retrospective interventional case series, 30 eyes with insufficient capsular support underwent IOL implantation using Meduri’s needle-guided single-suture technique at the G. Martino University Hospital, Messina. The surgical method employs a 24-gauge needle to guide a double-armed 10-0 polypropylene suture through the sclera for precise IOL anchorage, minimizing vitreous manipulation. Outcomes were assessed over 24 months, including best-corrected visual acuity (BCVA), IOL centration, intraocular pressure (IOP), and postoperative complications. Results: Mean BCVA improved from X to Y LogMAR at two years (p < 0.05) . All IOLs remained well-centered without tilt or decentration. Mild conjunctival hyperemia occurred in 70% of cases, resolving spontaneously. No suture erosion, vitreous hemorrhage, or retinal detachment was observed. Conclusions: The needle-guided single-suture technique provides a stable, efficient, and reproducible method for posterior chamber IOL fixation in aphakic eyes lacking capsular support. Its minimal learning curve and reduced surgical complexity make it an attractive alternative to both traditional sutured and modern sutureless methods, particularly in centers without vitreoretinal expertise. Keywords: scleral fixation; aphakia; IOL malposition; needle-guided scleral fixation 1. Introduction Scleral fixation of intraocular lenses (IOLs) remains one of the most effective surgical options for visual rehabilitation in patients lacking adequate capsular support due to trauma, iatrogenic zonular rupture, or congenital anomalies [1–3] . In these cases, placement of an IOL in the posterior chamber is anatomically desirable, as it maintains a physiological lens position and minimizes corneal endothelial damage and iris trauma [4–6] . Historically, fixation techniques have evolved substantially. Early approaches, such as those developed by Malbran and Binkhorst in the 1970s, relied on suturing posterior chamber IOLs to the sclera using 10-0 polypropylene [7] . W

FAQs

For which patients is needle-guided scleral fixation intended?

It is intended for aphakia and eyes with inadequate capsular support, where posterior chamber IOL placement is anatomically desirable.

How does the needle-guided single-suture technique work?

A 24-gauge needle guides a double-armed 10-0 polypropylene suture through the sclera for precise IOL anchorage, minimizing vitreous manipulation.

What were the key safety outcomes at 24 months?

All IOLs remained well-centered, and no suture erosion, vitreous hemorrhage, or retinal detachment was observed over the 24-month follow-up period.

Sep 30, 2026

Uploaded by Mary Man