Comparison of Clinical Outcomes of Iris Fixation and Scleral Fixation as Treatment for Intraocular Lens Dislocation

Abstract

To compare the efficacy and safety of iris fixation with scleral fixation in surgical repositioning of dislocated intraocular lenses (IOLs). Retrospective, consecutive, comparative interventional case series. setting: Referral hospital. Seventy-eight consecutive patients who underwent surgical repositioning of dislocated intraocular lenses using suturing to the sclera or iris. Forty-four eyes of 44 patients underwent scleral fixation and 35 eyes of 34 patients underwent iris fixation of dislocated intraocular lenses. Visual acuity, refractive stability, operation time, and perioperative complications, including recurrence of IOL dislocation. Corrected distance visual acuity (CDVA) improved significantly 1month postoperatively in both groups (P < .01 each), and remained stable for 12months. One week postoperatively, however, CDVA improved significantly in the scleral fixation (P= .040) but not in the iris fixation (P= .058) group. The amount of refractive error significantly diminished 1day after surgery (P= .028 in the scleral fixation and P= .046 in the iris fixation group). For the astigmatic components, Jackson crossed cylinders equivalent to conventional cylinders of positive power at axes of 0 degrees (J0) and 45 degrees (J45), J45 differed significantly in the scleral fixation and iris fixation groups (P= .009), whereas J0 was similar (P > .05). Operation time was significantly shorter (P= .0007), while immediate postoperative inflammation was significantly more severe (P= .001), in the iris fixation than in the scleral fixation group. Recurrence rates were similar (P > .05), but the mean time to recurrence was significantly shorter in the iris fixation than in the scleral fixation group (P= .031). Iris fixation and scleral fixation techniques had similar efficacy in the repositioning of dislocated intraocular lenses. Although operation time was shorter for iris fixation, it had several disadvantages, including induced astigmatism, immediate postoperative inflammation, earlier recurrence, and less stable refraction.