Flanged intrascleral fixation of a toric extended vision Alcon Vivity IOL in a paediatric patient with ectopic lentis from Marfans.

We used modifications to the 4 flange technique originally described by @dr_canabrava.

The plan was for in-the-bag placement with sutured capsular tensions segments and rings however there was over 270 degrees of zonular dehiscence and scleral fixation of the IOL was preferred. A 27 gauge system was used with 6-0 prolene sutures.

Centration and alignment of the IOL was relatively easy and secure. To prevent iris chaffing, the flanges on the IOL should be on the posterior surface of the lens.

The patient was slighy undercorrected to adjust for axial growth and was seeing 6/9 (20/30) by month 1 postop.

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