Scleral Fixated Intraocular Lens (SFIOLs)
At Pink City Eye & Retina Center, Jaipur, when a patient doesn’t have enough natural support in the eye to hold a regular intraocular lens (IOL), we turn to more specialized techniques—one of the most effective being the Scleral Fixated Intraocular Lens, or SFIOL. This is not a disease or eye condition itself, but rather a surgical solution used in certain complex or challenging eye cases.
What is a Scleral Fixated IOL?
A Scleral Fixated IOL (SFIOL) is an artificial lens that is placed inside the eye to help you see clearly. It is surgically fixed to the sclera, which is the white part of the eye.
This type of lens is used when the eye’s natural support system—like the capsular bag (which holds the lens) or zonules (fibers that support the lens)—is damaged or missing. In these cases, a regular lens can’t be safely used, so the SFIOL is a special solution that is securely attached to the eye’s white part, helping restore clear vision.
Who Needs a Scleral Fixated IOL (SFIOL)?
At Pink City Eye & Retina Center, Jaipur, we carefully assess each patient to determine the most appropriate treatment for their unique eye condition. In some cases, a Scleral Fixated Intraocular Lens (SFIOL) is the best solution, particularly for patients whose eyes have undergone trauma or complex surgeries. This technique is ideal when the natural lens support system (like the capsular bag or zonules) is compromised, making it difficult to place a regular intraocular lens (IOL).
Here’s a closer look at who typically needs an SFIOL:
- Patients Who Have Had Complicated or Traumatic Cataract Surgeries
Sometimes, cataract surgery can result in complications such as a ruptured capsule or disrupted zonules. If the normal lens implantation technique isn’t possible due to these issues, we use the SFIOL approach to safely position the lens in the eye, ensuring stable and clear vision. - Patients with Zonular Dialysis or Lens Subluxation
In cases where the natural lens or its supporting fibers (zonules) are weak or broken, such as in zonular dialysis or lens subluxation, it becomes difficult to securely implant an IOL in the usual place. SFIOLs are specially designed to be anchored securely in the sclera, allowing us to restore clear vision even in these complex cases. - Patients with Dislocated IOLs from Previous Surgeries
If you have had cataract surgery in the past and the IOL has become dislocated or moved out of place, the eye can experience blurry or double vision. In such cases, SFIOL surgery can help reposition or replace the dislocated lens, ensuring stability and excellent visual clarity. - Patients Born with Congenital Lens Problems (Like Marfan Syndrome)
Some individuals are born with congenital lens issues that lead to weak or absent zonules. This makes it difficult to keep the lens in its correct position. Conditions like Marfan Syndrome or ectopia lentis often require SFIOL placement to restore normal vision by securing a lens in a stable position within the eye. - Patients Experiencing Ocular Trauma That Affects the Eye’s Internal Structures
Any type of ocular trauma or injury, such as a blow to the eye or surgery complications, can lead to damage to the eye’s internal structures, including the lens and its support system. SFIOLs are used in these situations to safely implant an IOL in the proper anatomical location, helping to regain clear and stable vision.
How is Scleral Fixated IOL Surgery Done?
When the natural support system of your eye (like the capsular bag or zonules) is damaged or missing, a regular intraocular lens (IOL) cannot be placed in the usual position. That’s where Scleral Fixated IOLs (SFIOLs) come into the picture. This surgery requires advanced skills and is typically done by specialists like myself, using microsurgical techniques and precision tools.
Let me explain how the procedure works in a simple, step-by-step way:
- Pre-Surgical Preparation
Before surgery, we conduct a thorough eye examination and imaging to assess the condition of the eye and select the right type of IOL. We also ensure that the eye is infection-free and the retina is stable. You’ll have local or general anesthesia for the procedure, depending on your age, health, and how comfortable you are. - Small Incisions Are Made
Tiny incisions are made on the sclera—the white outer part of your eye—usually just behind the colored part (iris). These are very small, and heal quickly. The eye is kept stable and inflated using special fluids during surgery. - Lens Placement Technique
There are a few modern techniques for placing the SFIOL. At our Jaipur center, we choose the best one depending on your case: - Suture-Fixated Technique
• A special 3-piece IOL is used.
• The haptics (arms of the lens) are carefully sutured to the sclera using a very fine, non-reactive stitch.
• These sutures hold the lens firmly in place. - Glued IOL Technique
• The haptics are tucked into tiny scleral tunnels, created just under the surface.
• Then, a safe biological glue (fibrin glue) is used to seal the tunnel and secure the lens.
• This technique avoids stitches and offers faster healing with fewer complications. - Yamane Technique (Sutureless, Glueless)
• In this advanced method, the haptics are externalized through scleral tunnels using very fine needles.
• The ends of the haptics are slightly melted to form a bulb-like end, which gets tucked back into the sclera.
• This gives excellent fixation without the need for glue or sutures. - Lens Centering and Final Checks
Once the lens is secured, we carefully check to ensure it’s well-centered and stable. We may also perform a vitrectomy if needed (removing the gel from the back of the eye) to clear any opacities or support better IOL positioning. - Closing the Incisions
All incisions are either self-sealing or closed with very fine sutures. We then apply antibiotic and anti-inflammatory drops to prevent infection and inflammation. - Post-Operative Care
• Most patients can return home on the same day or after a brief period.
• You’ll be given medicated eye drops and a follow-up schedule.
• Your sight usually starts getting better in a few days or weeks, but it might take a couple of months to fully recover.
Benefits of Scleral Fixated IOLs (SFIOLs)
When the natural support structure of the eye is weak or missing—due to trauma, complicated cataract surgery, or certain eye conditions—Scleral Fixated Intraocular Lenses (SFIOLs) offer a safe and effective solution to restore vision. At Pink City Eye & Retina Center, I often recommend this advanced technique in special cases where traditional IOLs can’t be used.
Let me walk you through some of the key benefits:
Restores Vision in Complex Cases
SFIOLs are a lifesaver in situations where regular IOL implantation isn’t possible—like after trauma, previous complicated surgeries, or in patients with poor capsular support. This technique allows us to restore stable, clear vision even in eyes that have gone through a lot.
Provides Long-Term Stability
When done with precision, especially using techniques like glued IOL or sutureless methods, SFIOLs stay well-centered and stable in the eye for years. You don’t have to worry about lens shifting or dislocation, which sometimes happens with older or less advanced methods.
Safe Alternative to Anterior Chamber IOLs
In the past, if the capsular bag wasn’t intact, anterior chamber lenses were used—but they came with risks like corneal damage or glaucoma. SFIOLs are placed in the natural position of the lens, deep within the eye, which is more physiological and much safer in the long term.
Safe Alternative to Anterior Chamber IOLs
In the past, if the capsular bag wasn’t intact, anterior chamber lenses were used—but they came with risks like corneal damage or glaucoma. SFIOLs are placed in the natural position of the lens, deep within the eye, which is more physiological and much safer in the long term.
Minimal Visual Distortions
Because the lens is well-positioned in the eye's natural lens plane, SFIOLs often provide better visual outcomes compared to lenses that sit in the front part of the eye. Patients often experience less glare, halos, and optical disturbances, especially when the lens is properly centered.
Can Be Combined with Retina or Vitreous Surgery
Many patients who need SFIOLs also have coexisting retinal issues. At our center, we can combine SFIOL placement with vitrectomy or other retina procedures in the same sitting. This saves time, cost, and speeds up overall recovery.
Customized for Each Eye
No two eyes are the same. With SFIOLs, we can tailor the lens power, size, and technique to your individual eye condition. Whether it's a glued IOL, suture fixation, or Yamane technique, I select the best method based on what’s safest and most beneficial for your eye.
Improved Quality of Life
The ultimate goal is always to give you back your vision and confidence. Patients who’ve had poor or blurry vision for years due to dislocated lenses or failed surgeries often experience a significant improvement in their visual quality and overall comfort after SFIOL surgery.
Are there any risks?
Like all surgeries, SFIOL implantation does carry some risks, though complications are rare when done carefully. These may include:
• Suture erosion or breakage over time (in suture-based methods).
• Risk of retinal detachment or hemorrhage (though rare).
• IOL tilt or decentration.
• Infection or inflammation (as with any intraocular surgery).
We take all necessary precautions before, during, and after the surgery to minimize these risks and ensure the best visual outcomes.
Final Words from Dr. Abhishek Kothari
At Pink City Eye & Retina Center, Jaipur, our goal is always to restore vision in the safest and most effective way possible. For patients who cannot receive a regular lens implant, Scleral Fixated IOLs provide a wonderful alternative. It’s a specialized solution, but with the right technique and care, it can offer excellent and lasting visual improvement.
If you or a loved one have had a previous eye surgery complication, trauma, or lens dislocation, don’t worry—we’re here to evaluate your eyes carefully and recommend the best possible treatment tailored just for you.
Frequently Asked Questions (FAQs)
SFIOL surgery is generally very successful, with 72% to over 90% of patients seeing major vision improvement. Results often last for years, with lenses staying stable long-term—even over 20 years. Success depends on eye health, surgical technique, and surgeon experience.
In certain advanced techniques, especially in glued IOL surgery, we use a very safe and biocompatible medical glue known as fibrin glue. This glue is derived from human plasma and helps in securing the intraocular lens by fixing the haptics (lens arms) into the sclera.
Scleral lenses are custom-made and quite durable. If you take care of them, one pair can last about 1 to 3 years. However, we usually recommend an annual evaluation to check for any wear, deposits, or fit issues.
The better you care for your lenses—cleaning them regularly and storing them properly—the longer they’ll serve you comfortably.
The cost of SFIOL surgery in Jaipur can vary depending on the complexity of the case, the type of lens used, and whether additional procedures like vitrectomy are needed.
At Pink City Eye & Retina Center, we strive to keep our prices fair and transparent. Typically, the price ranges from ₹35,000 to ₹80,000, depending on the surgical technique (sutured vs. glued), the lens brand, and technology involved.
Scleral lenses are made from highly oxygen-permeable rigid gas-permeable (RGP) materials. These materials let oxygen reach your eye while staying firm, so you can see clearly.
This is very important for corneal health, especially since scleral lenses cover a larger area than regular lenses.
Modern materials used at our Jaipur clinic are designed to be safe, comfortable, and gentle on the eye.
While scleral lenses offer excellent vision and comfort, especially in irregular corneas or dry eyes, there are a few challenges:
- Learning curve: Inserting and removing them requires a little practice.
- Cost: They are more expensive than regular lenses due to customization.
- Cleaning: They need meticulous cleaning and care every day.
- Initial comfort: Some patients feel slight discomfort or awareness at first, which usually improves with time.
At our Jaipur center, we guide you step-by-step, offer training on lens handling, and provide full support until you’re fully confident and comfortable.
Scleral lenses can typically be worn for 10 to 14 hours a day comfortably. Many patients wear them from morning till evening without issues. However, I always recommend taking short breaks and removing the lenses before sleeping.
Your eye health is our top priority, so we personalize the wearing schedule based on your eye’s response, tear quality, and comfort.
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