Transsclerally Sutured Posterior Chamber Intraocular Lens in the Absence of Capsular Support: Analysis of 30 Cases

Abstract

During a four-year period from August 1989 to July 1993, 30 consecutive aphakic patients without capsular and zonular support underwent transscleral fixation of posterior chamber intraocular lens (IOL). The haptics of the IOL were fixed in the ciliary sulcus and sutured on the sclera, which resulted in excellent centration and stability of the implant. No major complication was encountered intraoperatively. Twenty eyes (67%) achieved postoperative visual acuity of 20/40 or better. The best-corrected final postoperative visual acuity was either better than or within one Snellen line of best-corrected preoperative vision in 90% of cases whereas only three eyes lost more than two lines. At subsequent follow-up, subluxation of the implant occurred in one eye (3%), which was resutured and achieved 20/30 vision. Other postoperative complications, such as retinal detachment and corneal decompensation, occurred respectively in two patients. Both were successfully treated with scleral buckling and corneal transplantation and attained visual acuity 20/30 and 20/40. Of the three eyes (10%) with glaucoma, two were controlled medically and one underwent cyclodestructive procedure to control intraocular pressure. Knot exposure occurred in four eyes (13%) and was trimmed without sequel. From the visual prognosis of our series, transscleral fixation of posterior chamber lens appears to be a viable alternative to improve functional visual acuity in acapsular aphakic patients. However, prolonged observation of the implant stability and inherent complications of surgery cannot be overlooked.