To investigate the surgical outcomes of scleral fixation with either pars plana vitrectomy (ppV) or anterior vitrectomy (AV) for the treatment of dislocated intraocular lens (IOL). By retrospective review of electronic medical records, patients with in-the-bag spontaneous IOL dislocation who underwent IOL exchange with scleral fixation were included and grouped according to the vitrectomy method: ppV (group 1) and AV (group 2). Post-operative surgical outcomes including visual acuity (log MAR), spherical equivalent, and surgically induced astigmatism (SIA) and complications were investigated and analyzed. After 6 months, post-operative measurements showed an average visual acuity of 0.16 ± 0.20, spherical equivalent of −1.48 ± 1.53D (diopters), and refractive shift of −0.19 ± 0.44D in group 1 (n = 19). There was no statistically significant difference between the measurements of group 1 and group 2 (n = 20) (0.10 ± 0.12, −2.00 ± 1.71D, −0.39 ± 0.57D, respectively) (p = 0.51, p = 0.29, p = 0.16, respectively). When analyzed by the algebraic and vector methods, group 1 did show a higher magnitude of surgically induced astigmatisms (1.61 ± 1.50D, 2.10 ± 1.03D, respectively) than did group 2 (0.49 ± 1.02D, 1.31 ± 0.83D respectively) (both p’s = 0.01). There was no significant difference in the incidence of complications except for vitreoretinal complications, which were higher in group 2 (25%), compared with group 1 (0%) (p = 0.047). Both ppV and AV are appropriate options in patients who need IOL exchange with scleral fixation based on visual outcomes, refractive shifts, and complication rates. In terms of managing astigmatism, the AV procedure may be the better option.