To compare the efficacy and safety of conventional scleral fixation, retropupillary iris-claw intraocular lens (IOL) implantation, and intrascleral fixation. This retrospective observational study included 58 patients (58 eyes) who underwent conventional scleral fixation (C-SF, 23 eyes), retropupillary iris-claw IOL implantation (RP-IOL, 23 eyes), and intrascleral fixation (ISF, 12 eyes) by a single surgeon at Samsung Medical Center from October 2017 to July 2020 and were followed up for at

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... t 6 months. This study analyzed various clinical outcomes before and 1 day, 1 week, 1 month, 3 months, and 6 months after surgery. Six months after surgery, best-corrected visual acuity (BCVA) in logarithm of minimum angle of resolution was 0.08 ± 0.10, 0.08 ± 0.16, and 0.03 ± 0.04 in C-SF group, RP-IOL group, and ISF group, respectively, and there was a significant improvement in each group compared to preoperative BCVA. All groups showed a significant increase in astigmatism postoperatively, but no between-group differences were observed. The prediction error was -0.15 ± 0.77, 0.56 ± 0.62, and 0.44 ± 1.00 diopters in the three groups, respectively, indicating RP-IOL group and ISF group for hyperopic shift. The three groups did not differ in terms of absolute prediction error. Six months after surgery, the corneal endothelial cell counts were 2073 ± 691, 2014 ± 692, and 1712 ± 891 cells/mm2, respectively, which were lower than before surgery. IOL dislocation occurred in five eyes only in RP-IOL group, two of which underwent two reoperations, and re-enclavation was performed smoothly without complications in all cases. Although the frequency of IOL dislocation in RP-IOL group was higher than that in the other groups, it can be re-enclavated relatively easily. As a method of secondary IOL fixation, both RP-IOL implantation and intrascleral fixation were as effective as conventional scleral fixation.