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Purpose To assess the long-term results and complications of scleral-fixated posterior chamber intraocular lenses (PC IOLs) with the knotless Z-suture technique. Setting University Eye Hospital, Tübingen, Germany. Design Retrospective case series. Methods Records of consecutive patients who had implantation of scleral-fixated PC IOLs with the knotless Z-suture technique with a minimum follow-up of 3 years were reviewed. Results Sixty-six eyes of 62 patients were included. The mean preoperative corrected distance visual acuity (CDVA) was 0.71 logarithm of the minimum angle of resolution (logMAR) ± 0.58 (SD). The mean CDVA was 0.67 ± 0.54 logMAR ( P = .257; n = 66) after 3 years, 0.73 ± 0.55 logMAR ( P = .399; n = 60) after 5 years, 0.8 ± 0.68 logMAR ( P = .348; n = 30) after 8 years, and 1.09 ± 0.76 logMAR ( P = .069; n = 13) after 10 years. Failure because of suture breakage was observed in 11 eyes (16.7%) after a mean of 7.5 years. Kaplan-Meier time-to-event analysis showed a 40% failure probability after 10 years. Traumatic aphakia was the only risk factor for failure (odds ratio 4.1; 95% confidence interval, 1.0-18.3; P = .049). Complications included retinal detachment (15%), cystoid macular edema (9%), increased intraocular pressure requiring surgical intervention (7.6%), corneal edema (4.5%), and posterior iris-chafing syndrome with microhyphema (3%). Conclusions Implantation of scleral-fixated PC IOLs using the knotless Z-suture was a safe technique resulting in good visual outcomes. The long-term success of the procedure was dependent on the material properties of the suture. [ABSTRACT FROM AUTHOR]