@article{Zhang2026, 
author = {Zhao-Liang Zhang and Jia-Hui Shen and Jun-Yi Chen and Qin-Tuo Pan and Xu-Ting Hu and Zong-Duan Zhang},
title = {Minimally invasive four-point scleral refixation for dislocated 4-haptic IOL by horizontal mattress sutures and Hoffman pockets},
year = {2026},
journal = {International Journal of Ophthalmology},
volume = {19},
number = {3},
pages = {483-489},
keywords = {intraocular lens dislocation, four-haptic intraocular lens, intraocular lens refixation, scleral fixation, horizontal mattress suture, Hoffman pocket, minimally invasive ophthalmic surgery},
url = {https://www.sciopen.com/article/10.18240/ijo.2026.03.08},
doi = {10.18240/ijo.2026.03.08},
abstract = {AIMTo evaluate the clinical outcomes of a new minimally invasive technique using horizontal mattress sutures and Hoffman pockets for four-point refixation of dislocated four-haptic intraocular lenses (IOLs).METHODSThis retrospective consecutive case series included eyes with dislocated Akreos AO60 IOLs underwent scleral refixation using a horizontal mattress double-needle suture technique with intralamellar knot burial via Hoffman pockets. Clinical outcomes assessed included pre- and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), spherical equivalent (SE), suture duration, IOL centration, and perioperative complications.RESULTSA total of 10 eyes from 10 patients (6 males) were included. The mean age at the time of IOL refixation was 53.10±13.07y (range: 28–68y). The mean interval between initial IOL implantation and dislocation was 8.44±3.54y. The mean postoperative follow-up duration was 11.45±10.30mo. Surgical time averaged 15.3±1.77min, with no intraoperative complications. The mean axial length was 27.16±4.35 mm, with high myopia (HM) as the leading comorbidity (4/10 eyes). Postoperative BCVA significantly improved compared to preoperative values (P=0.025). Postoperative SE was significantly improved compared with preoperative (P=0.01). All IOLs remained centered throughout follow-up.CONCLUSIONThis minimally invasive four-point scleral fixation technique offers a safe and effective refixation strategy for dislocated four-haptic IOLs. The horizontal mattress suture configuration combined with Hoffman pockets facilitates durable centration, avoids conjunctival dissection, and could be adopted into routine surgical practice.}
}