Long-term outcomes of modified glued versus flanged intrascleral haptic fixation techniques for secondary intraocular lenses.

Abstract

To report the long-term refractive outcomes and complications of two scleral fixation techniques for secondary intraocular lenses (IOL). Consecutive patients who underwent secondary IOL insertion at a tertiary care academic hospital using either modified glued ("glued") or flanged intrascleral haptic fixation (FISHF) techniques with over 12months of follow-up were retrospectively reviewed. Pre- and postoperative corrected distance visual acuity (CDVA), postoperative complications, and refractive surprises were reported. Thirty-eight patients underwent "glued" fixation and 22 underwent FISHF, with mean follow-up times of 3.1 ± 0.5 and 2.0 ± 1.2years, respectively. Aphakia secondary to trauma was the main surgical indication. MA50BM or MA60AC IOLs (Alcon Laboratories Inc., Fort Worth, TX) were implanted in 92% of "glued" patients, while CT Lucia 602 IOLs (Carl Zeiss Meditec Inc., Dublin, CA) were used in 96% of FISHF patients. Postoperative spherical equivalent significantly improved compared to preoperative values (p < 0.001). No significant difference in CDVA was seen between the two techniques. FISHF resulted in mean hyperopic surprises of + 0.81D and + 0.69D using the Holladay 2 and Barrett Universal II formulae, respectively, which was significantly greater than the "glued" patients. A higher rate of IOL dislocation was seen in the "glued" cohort (13%) compared to FISHF (0%). Retrospective long-term outcomes of patients with complex ocular comorbidities undergoing a modified "glued" technique demonstrated a higher rate of IOL dislocation but more predictable refractive outcomes compared to the FISHF technique. The FISHF technique resulted in a significant hyperopic shift using fourth-generation IOL calculators.