Comparison of three types of scleral fixation of intraocular lens

Abstract

AbstractPurpose: To compare the clinical outcomes of three different surgical methods of scleral fixation of intraocular lens (IOL); Conventional Ab‐externo sutured scleral fixation, modified Yamane sutureless fixation and Four‐point scleral fixation.Methods: This was a single referral center, one surgeon, retrospective study. Main outcome measures included best‐corrected visual acuity (BCVA), spherical equivalent (SE) and surgically induced astigmatism (SIA). To find out how much astigmatism purely occurred by surgery, excluding the effect of corneal astigmatism, SIA was calculated at 1 year after surgery. Clinical outcomes were compared before and 1‐, 3‐, 6‐ and 12‐month follow‐ups after the operation.Results: Total 75 eyes underwent scleral fixation of IOL: 22 eyes in the 4‐point fixation, 30 eyes in the modified Yamane and 23 eyes in the conventional sutured group. From 1 month after surgery, mean BCVA recovered significantly faster in the order of 4‐point, modified Yamane and conventional groups (0.12 ± 0.11 vs. 0.25 ± 0.21 vs. 0.34 ± 0.25 logMAR, p = 0.004), also showed the same tendency in cylindrical error values (−1.15 ± 0.77 vs. −1.54 ± 0.94 vs. −2.06 ± 1.56 diopter, p = 0.031). The modified Yamane group had the shortest operation time and the conventional group was the longest (7.25 ± 1.22 vs. 18.44 ± 4.05 vs. 25.19 ± 6.26 min, p < 0.001). In terms of SIA, 4‐point fixation caused significantly less astigmatism (1.13 ± 0.59 vs. 1.67 ± 1.02 vs. 2.43 ± 1.42 diopter, p = 0.001).Conclusions: 4‐point fixation technique showed the strengths of faster vision recovery, less cylindrical error and lower SIA values. The modified Yamane group had the shortest operation time attributed to the relatively simple procedure, however, has a weakness with the higher complication rate of IOL malposition, which might require reoperation. Both techniques have each pros and cons, but provide more favourable clinical outcomes than the conventional sutured fixation.