Purpose: We compared the surgical outcomes and complications of conventional, sutured scleral fixation and flanged intrascleral intraocular lens (IOL) fixation. Methods: We retrospectively analyzed the medical records of patients who underwent conventional, sutured scleral fixation or flanged intrascleral IOL fixation and who were then observed for more than 6 months. The best-corrected visual acuity (BCVA), operation time, spherical equivalent (SEQ), astigmatism, and postoperative complications were recorded up to 6 months after surgery. Results: Of sixty-nine enrolled eyes, 39 underwent conventional, sutured scleral fixation (“sutured” group) and 30 flanged intrascleral IOL fixation (“sutureless” group). The operation time was significantly shorter in the sutureless group than in the sutured group (56.3 ± 11.8 vs. 77.7 ± 17.9 minutes, p < 0.001). In both groups, the BCVA and SEQ improved significantly at all visits after surgery compared to the baseline values p < 0.05). There was no between-group difference in BCVA, SEQ, astigmatism, or complications. Conclusions Compared to conventional, sutured scleral fixation, flanged intrascleral IOL fixation afforded equivalent improvements in visual acuity but with a shorter surgical duration. Therefore, flanged intrascleral IOL fixation is a useful alternative to conventional, sutured scleral fixation.

Purpose: We describe a case with retinal alterations similar to those of nonischemic central retinal vein occlusion, but also with superior ophthalmic vein compression attributable to a traumatic, subperiosteal orbital hematoma.Case summary: A 13-year-old male presented with left periorbital edema, a decrease in vision, and diplopia after blunt periorbital trauma. In ophthalmological evaluations, the best-corrected visual acuity (BCVA) was 0.4 (20/50) and a severe supraduction limitation was apparent (grade -4). Fundus examination revealed optic disc swelling, retinal vein dilation/tortuosity, and an arteriovenous transit time delay of 26s. Fluorescein angiography evidenced optic disc leakage. Ocular sonography and orbital magnetic resonance imaging revealed a superior subperiosteal hematoma in the left orbit accompanied by superior ophthalmic vein compression. We scheduled emergency hematoma evacuation. One month later, the BCVA had increased to 1.0 (20/20) and ocular movement was no longer limited. Orbital computed tomography showed that the superior ophthalmic vein compression had resolved and that the abnormalities observed in the initial fundus examination and fluorescein angiography had improved. Conclusions Retinal changes that resemble nonischemic central retinal vein occlusion including retinal venous dilation and tortuosity may develop after a traumatic, orbital subperiosteal hematoma. Compressive obstruction of the superior ophthalmic vein may then be in play. Early surgical intervention featuring hematoma evacuation may prevent irreversible visual deterioration.