| Sumario: | Background: Moderate-to-severe lens subluxation poses surgical challenges due to extensive zonular weakness and the need to maintain stable intraocular lens (IOL) positioning while preserving the capsular bag. Objectives: To evaluate the outcomes and safety of a modified technique using intrascleral suture fixation of a standard capsular tension ring (CTR) to preserve the capsular bag in moderate-to-severe lens subluxation. Design: Retrospective, single-center case series. Methods: Consecutive eyes with 120°–300° zonular dialysis underwent phacoemulsification via a 2.4 mm clear corneal incision and a 0.8 mm lateral incision. Capsular bag stabilization was achieved by intrascleral fixation of a standard CTR using a knotless Z-suture with double-strand 8–0/9-0 polypropylene, followed by in-the-bag IOL implantation. Primary outcomes were postoperative IOL centration and corrected-distance visual acuity (CDVA); secondary outcomes included refractive error and complications. Follow-up was scheduled at 1, 3, 6 months (some at 12 months) and annually thereafter. Results: Sixteen eyes of nine patients were included. Median follow-up was 328.0 days (interquartile range (IQR) 256.5, 443.0). Median logMAR CDVA improved from 0.35 (IQR 0.30, 0.57) preoperatively to 0.19 postoperatively. Mean absolute spherical equivalent decreased from 9.82 ± 1.02 D to 1.16 ± 0.25 D. IOLs were well‑centered in 13 eyes (81.3%); a slight, clinically insignificant tilt was observed in 3 eyes (18.7%). One intraoperative posterior capsule rupture did not preclude in-the-bag IOL implantation. Two eyes had transient postoperative intraocular pressure elevation managed medically. No other significant complications occurred. Conclusion: Intrascleral fixation of a standard CTR is a simple, accessible, and effective bag-preserving technique for moderate-to-severe lens subluxation, enabling stable in-the-bag IOL implantation with favorable visual and refractive outcomes. Registration: ClinicalTrials.gov: NCT06627062. Plain language summary: This technique offers a simplified, cost-effective solution for complex lens subluxation cases, making it accessible even in resource-limited settings. It provides a reliable approach for maintaining IOL alignment and improving surgical outcomes, with potential for broader clinical adoption in diverse healthcare environments. This study introduces a simple and effective surgical technique for patients with severely dislocated lenses, known as "subluxation." This condition occurs when the lens in the eye shifts from its usual position, causing vision problems. The new method involves using a standard capsular tension ring (CTR), a small device that helps stabilize the lens, along with a special type of suture (a surgical thread) to fix the ring in place within the eye. The technique was tested on 16 eyes of 9 patients, most of whom had congenital lens dislocation. The results were promising: all patients had successful lens implantations, and their vision improved after surgery. No serious complications were observed, and the eye's structure remained stable after the operation. The method was particularly useful for patients with large dislocations, where traditional methods might not work as well. This new technique is easier to perform than other more complicated methods, and it doesn't require specialized equipment that may not be available in all places. It provides a reliable option for doctors to treat patients with severe lens dislocations, particularly in countries where advanced devices are difficult to access. Further studies are needed to confirm the long-term effectiveness of this approach.
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