TOPIC: To evaluate the complication rates of different intraocular lens (IOL) placement methods in adults with inadequate capsular bag support. CLINICAL RELEVANCE: The surgical correction of inadequate capsular bag support for the IOL harbors several challenges, and there is a wide range of surgical procedures. METHODS: For the purpose of this meta-analysis, surgical methods were grouped based on the location of IOL placement: (1) anterior chamber (AC) placement
(2) iris fixation, which included prepupillary or retropupillary placement of an iris-claw IOL, or iris suturing of an IOL
and (3) scleral fixation, which included scleral sutured and sutureless techniques. Only studies comparing the results of 2 or more different placement methods were analyzed. The study protocol has been registered in the PROSPERO database (CRD42023458557). RESULTS: 15 studies were included in the final analysis, which reported results of 1247 eyes. The overall complication rate was nonsignificantly lower in iris fixation (4.4%
95% CI, 3.6%-5.4%, P = .150) than in AC placement (7.4%
95% CI, 6.4%-7.9%) and scleral fixation (7.4%
95% CI, 6.5%-8.4%). Transient corneal edema was the most common complication in AC placement (29.9%
95% CI, 2.4%-57.5%, P <
.001), compared with scleral fixation (11.9%
95% CI, 2.6%-21.2%) and iris fixation (4.1%
95% CI, 0.8%-7.3%). Vitreous hemorrhages were more frequently reported after scleral fixation (8.5%
95% CI, 6.3%-11.2%, P = .006) than in AC placement (5.4%
95% CI, 3.4%-8.5%) and iris fixation (1.4%
95% CI, 0.4%-4.2%), and so was IOL decentration/dislocation (8.9%
95% CI, 6.7%-11.8%, P = .047 compared with 1.1%
95% CI, 0.4%-3.4% and 4.0%
95% CI, 2.2%-7.3%, respectively). CONCLUSIONS: The risks associated with particular techniques should be taken into account in preoperative counseling and planning postoperative treatment.