Intraocular lens tilt and decentration, anterior chamber depth, and refractive error after trans-scleral suture fixation surgery

Abstract

Objectives To compare the extent of intraocular lens (IOL) tilt and decentration, as well as the anterior chamber depth after trans-scleral suture IOL fixation after either secondary out-of-the-bag or primary in-the-bag IOL implantation. Design Retrospective, comparative, nonrandomized, interventional study. Participants Fifty-two eyes that underwent scleral suture fixation were compared with 51 eyes that underwent secondary out-of-the-bag implantation and 50 eyes that underwent in-the-bag implantation. Intervention One-piece polymethyl methacrylate IOL implantation by three different techniques. Main outcome measures The tilt angle and decentration length of the IOL, as well as the anterior chamber depth, were measured by the Scheimpflug videophotography system. The spherical equivalent error from the predicted value was also examined. Results The mean tilt angle in the scleral suture fixation group was significantly greater than that in either the out-of-the-bag or the in-the-bag implantation group ( P < 0.0001). The mean decentration length was also largest in the suture group, followed by the out-of-the-bag group and the in-the-bag group ( P < 0.0001). The anterior chamber depth in the suture group and the out-of-the-bag group was significantly smaller than that in the in-the-bag group ( P < 0.0001). The spherical equivalent error in the suture group and the out-of-the-bag group was also greater than that in the in-the-bag group ( P < 0.0001). Conclusions The extent of both tilt and decentration after scleral suture fixation was greater than that observed after either out-of-the-bag or in-the-bag implantation. The anterior chamber depth with the sutured or out-of-the-bag fixated IOL was shallower than that with the in-the-bag fixated IOL, which resulted in a significant myopic shift.