Illustration showing ab externo scleral fixation technique. A, Scleral flaps are created 180 degrees apart. A single-armed suture on a straightened needle is passed under the scleral flap approximately 2 mm posterior to the limbus. The suture needle is retrieved by a hollowbore guide needle under the opposite scleral flap. This process is repeated from the opposite direction. B, The 2 suture loops are externalized through the main limbal incision. C, The cut suture ends are tied to eyelets of the IOL haptic. The IOL is internalized through the limbal incision, and the sutures are tied under the scleral flaps. D, The limbal incision, scleral flaps, and conjunctiva are closed.