AIM: To evaluate the refractive outcomes after intrascleral fixation of posterior intraocular lens(IOL).METHODS: Retrospective clinical study. A total of 55 patients(55 eyes)who had undergone intrascleral fixation of posterior IOL in Peking University International Hospital from March 2017 to December 2021 were enrolled. Patients were assigned to conventional group(35 eyes)and modified group(20 eyes)according to different surgical procedures. IOL Master combined with SRK/T formula were applied to calculate the diopter of IOL and the residual refractive power, as well as acquiring preoperative values of corneal astigmatism. Optometry, IOL Master and Pentacam were performed 1 and 3mo postoperatively to obtain the postoperative corneal astigmatism, total ocular astigmatism and spherical equivalent which was calculated as the actual diopter. The Image-pro plus analyzer was used to measure the values of IOL tilt and decentration.RESULTS: The 55 eyes that underwent intrascleral fixation of posterior IOL presented hyperopic shift in refraction after operation and the refractive error was 0.75±0.63D at 3mo postoperatively. There was significant difference between the actual diopter and the residual diopter at 3mo after operation(t=2.553, P=0.011). Both conventional group and modified group showed hyperopic shift postoperatively. The refractive error at 1 and 3mo after operation were 0.80±0.43 and 0.84±0.46D in the conventional group and 0.43±0.39 and 0.47±0.26D in the modified group respectively, with significant differences between two groups(1mo: t=3.500, P=0.001; 3mo: t=3.311, P=0.002). There was no significant difference in corneal astigmatism between two groups both at 1 and 3mo postoperatively(all P<0.05). Total ocular astigmatism in the modified group was significantly lower than that in the conventional group(1mo: t=3.884, P<0.001; 3mo: t=3.314, P=0.002). In addition, IOL tilt and decentration in the modified group were significantly less than that in the conventional group at 1 and 3mo postoperatively(all P<0.05). No significant difference was found in IOL tilt and decentration for intra-group comparison at 1 and 3mo postoperatively(P<0.05). Complications of 55 eyes included 2 eyes of transient intraocular pressure elevation, 2 eyes of transient hypotony which recovered after topical medication and 1 eye of vitreous hemorrhage which resolved spontaneously.CONCLUSION: Intrascleral fixation of posterior IOL is proved to be a safe and effective surgical technique, with hyperopic shift easily present after operation. Increasing the refractive power of IOL and targeting mild myopia during IOL power calculation can prevent postoperative hyperopia, but long-term outcomes still need further observation.