Complications in sutured scleral fixation of artificial lens implantation

Abstract

Sutured scleral fixation of an artificial posterior chamber lens is afrequently used method for the treatment of eyes with poor or absent capsular support; however, the complication profile is often considered unfavorable. To analyze the postoperative complication profile. In this monocentric and retrospective analysis of a consecutive case series of patients with standardized sutured scleral fixation of aposterior chamber lens between 2007 and 2017, the documented complications were categorized as a permanent threat to visual acuity, such as endophthalmitis, choroidal hemorrhage, retinal detachment and clinically relevant but without a permanent threat to visual acuity, such as hemorrhage and hypotension. Additionally, the time point when complications first occurred was categorized into the 3 periods 0-3, 4-30 and ≥31days. This is the largest patient collective of a study with scleral fixation of aposterior chamber lens published so far. A total of 338 eyes from 338 patients were included in the study (women 47%) and the median postoperative follow-up period was 60days (range 1-5833 days). In 68% of the patients at least 1 complication was documented. Complications with apermanent threat to visual acuity occurred in 3% (n = 10) of the patients. The most frequent clinically relevant complications were intraocular hypotension ≤10 mm Hg (35%; n = 119), pupil decentration (28%; n = 93), hyphema, iris or vitreous hemorrhage (10%; n = 34), secondary glaucoma (9%; n = 32) and iris capture (5%; n = 17). Of the complications 41% occurred within the first 3days and 70% within the first 30days. Revision surgery was carried out in 4.5% (n = 15) of the patients. Although complications occurred in two thirds of the interventions, the number of permanent complications with a permanent threat to visual acuity was low. Scleral fixation of an artificial posterior chamber lens is still a justifiable intervention.