Long-term outcome of scleral-fixated posterior chamber intraocular lens implantation with the knotless Z-suture technique

Abstract

To assess the long-term results and complications of scleral-fixated posterior chamber intraocular lenses (PC IOLs) with the knotless Z-suture technique. University Eye Hospital, Tübingen, Germany. Retrospective case series. Records of consecutive patients who had implantation of scleral-fixated PC IOLs with the knotless Z-suture technique with a minimum follow-up of 3years were reviewed. Sixty-six eyes of 62 patients were included. The meanpreoperative corrected distance visual acuity (CDVA) was0.71 logarithm of the minimum angle of resolution (logMAR)±0.58 (SD). The mean CDVA was 0.67±0.54 logMAR (P=.257; n=66) after 3years, 0.73±0.55 logMAR (P=.399; n=60) after 5years, 0.8±0.68 logMAR (P=.348; n=30) after 8years, and 1.09±0.76 logMAR (P=.069; n=13) after 10years. Failure because of suture breakage was observed in 11 eyes (16.7%) after a mean of 7.5years. Kaplan-Meier time-to-event analysis showed a 40% failure probability after 10years. Traumatic aphakia was the only risk factor for failure (odds ratio 4.1; 95% confidence interval, 1.0-18.3; P=.049). Complications included retinal detachment (15%), cystoid macular edema (9%), increased intraocular pressure requiring surgical intervention (7.6%), corneal edema (4.5%), and posterior iris-chafing syndrome with microhyphema (3%). Implantation of scleral-fixated PC IOLs using the knotless Z-suture was a safe technique resulting in good visual outcomes. The long-term success of the procedure was dependent on the material properties of the suture.