Background <p>To compare visual, refractive, and anatomical outcomes of lens extraction with Cionni ring and in-the-bag intraocular lens (IOL) implantation and Yamane intrascleral fixation in pediatric Marfan patients with lens subluxation.</p> Methods <p>This retrospective cohort study included 21 patients (29 eyes) who underwent IOL implantation for ectopia lentis due to Marfan syndrome. Surgical techniques included Yamane sutureless scleral fixation and scleral fixation with Cionni capsular rings. Postoperative outcomes assessed were corrected visual acuity (CVA) in decimal, spherical equivalent (SE) refraction, lenticular astigmatism, IOL tilt/decentration, endothelial cell count, and complications.</p> Results <p>Sixteen eyes were included in the Yamane group and 13 in the Cionni group. Both groups demonstrated a significant improvement in CVA compared to preoperative values (Yamane, <i>p</i> = 0.001; Cionni <i>p</i> = 0.002). A significant postoperative improvement in SE was also noted in Yamane group (<i>p</i> = 0.009). The degree of IOL tilt was comparable between groups (Yamane, 0.80 ± 0.27°; Cionni, 1.33 ± 0.93°; <i>p</i> = 0.240); however, IOL decentration occurred in 4 eyes in the Cionni group and 3 eyes in the Yamane group. No major intraoperative complications were reported. Among the postoperative complications, retinal pathology and glaucoma each occurred in 2 patients in the Yamane group. The median postoperative follow-up duration was 16.6 (min-max: 7–34 months) months in the Modified Yamane group and 22.6(min-max: 8–35 months) months in the Cionni group (<i>p</i> = 0.232).</p> Conclusions <p>In patients with lens subluxation secondary to Marfan syndrome, IOL implantation using either the Yamane technique or the Cionni ring yields favorable anatomical and functional outcomes. These methods may be considered viable options following thorough preoperative assessment, particularly when the risk of intraoperative and postoperative complications is deemed low.</p>