Scleral-fixated Intraocular Lens Implantation Research Articles

The visual outcome and surgical complications in posterior capsular rupture following cataract surgery with scleral fixated intraocular lens in tertiary care centre – A prospective study

Aim: To analyse the complications as well as the long term functional and visual outcomes of anterior vitrectomy with scleral fixated posterior chamber intraocular lens implantation in patients with inadequate posterior capsular support. Settings and Design: This was a prospective study done at Coimbatore Medical College Hospital, Coimbatore during the period of May 2016 to December 2017. Materials and Methods: 30 eyes of 25 aphakic patients and 5 patients who had primary scleral fixated IOL implantation were included in the study. Anterior segment examination with slit lamp, preoperative visual acuity, intraocular pressure, fundus examination and IOL power calculation was done. Results: Scleral fixation of IOL is a safe procedure with a success rate of 93% and most of the intraoperative and postoperative complications were minor. Postoperative best corrected visual acuity of 6/12 and above was seen in 70% of patients. Conclusion: Anterior vitrectomy with scleral fixated IOL implantation is a safe and effective procedure to correct aphakia in eyes without adequate posterior capsular support. Complications seen with anterior chamber IOL are not seen with SFIOL and dreaded complications like retinal detachment, suture lysis and infection were not encountered in our study. However precise determination of small differences in visual outcome and long-term complication rates would require a large prospective, randomized clinical trial. Keywords: Aphakia, Inadequate posterior capsular support, Scleral fixated IOL.

Long-term outcome of scleral-fixated intraocular lens implantation without conjunctival peritomies and sclerotomy in ocular trauma patients

BackgroundTo investigate the long-term outcomes and complications of scleral-fixated intraocular lens (SFIOL) implantation without conjunctival peritomies and sclerotomy in patients with a history of ocular trauma with inadequate capsular support during primary pars plana vitrectomy or silicone oil removal.MethodsRecords of ocular trauma patients who underwent implantation of SFIOL without conjunctival peritomies and sclerotomy during primary pars plana vitrectomy or silicone oil removal.ResultsSixty-nine eyes of 69 patients were included in this study. The median follow-up period was 34 months (range, 6–99 months). The average patient age at the time of surgery was 44 years old (range, 4–80 years). At the end of follow-up, the preoperative mean of best corrected visual acuity (BCVA) was 0.79 ± 0.86 log of the minimum angle of resolution (logMAR), which improved 0.20 ± 0.26 logMAR postoperatively (P = 0.01). BCVA improved or remained unchanged in 64 eyes (92.8%), VA decreased two lines in five eyes (7.2%). Early postoperative complications included transient corneal edema in seven eyes (10.1%), minor vitreous hemorrhage in four eyes (5.8%), transient elevated intraocular pressure (IOP) in one eye (1.4%), and hypotony in three eyes (4.3%). Late postoperative complications included persistent elevated IOP in five eyes (7.2%), epiretinal membrane formation in three eyes (4.3%), and cystoid macular edema noted in one eye (1.4%).ConclusionsUse of a scleral-fixated intraocular lens implantation without conjunctival peritomies and sclerotomy in ocular trauma patients during either primary pars plana vitrectomy or second silicone oil removal is a valuable approach for the management of traumatic aphakia in the absence of capsular support.

Scleral Fixation of Intraocular Lenses with Gore-Tex Suture: Refractive Outcomes and Comparison of Lens Power Formulas

To report refractive outcomes of scleral-fixated intraocular lens (IOL) implantation with Gore-Tex (W.L. Gore & Associates, Newark, DE) suture and combined pars plana vitrectomy and compare predicted refractive outcomes among 5 IOL power calculation formulas. Retrospective case series. Patients undergoing scleral-fixated IOL implantation with Gore-Tex suture at our institution between January 2015 and June2018. Comparison of preoperative biometrics with postoperative refraction and calculation of predicted refractive outcome with 5 different IOL formulas. Prediction error and absolute error to compare postoperative refraction with refraction predicted by lens power calculation formulas. Thirty-one eyes of 31 patients were included. All power calculations assumed in-the-bag position of the IOL. The Akreos A060 (Bausch & Lomb, Rochester, NY) was implanted in 23 eyes and the CZ70BD (Alcon, Fort Worth, TX) in 8 eyes, and all lenses were sutured 3 mm behind the limbus. Average postoperative spherical equivalent (SE) was -0.79±0.95 diopters (D). Average prediction error (postoperative SE refraction minus target refraction) was -0.19±0.72 D. Postoperative SE was within 1.0 D of target in 25 of 31 patients (81%) and 2.0 D of target in 31 of 31 patients (100%). The repeated-measures analysis of variance of absolute error by lens power formula was significant (P= 0.012), with Haigis demonstrating greater error. There was no significant difference among Barrett II, Sanders-Retzlaff-Kraff theoretical (SRK/T), Holladay 2, or Hoffer Q. For eyes undergoing pars plana vitrectomy with scleral-sutured IOL implantation, assumption of in-the-bag IOL position when calculating lens power leads to acceptable refractive outcomes. Barrett II, SRK/T, Holladay 2, and Hoffer Q formulas were noninferior to each other.

Outcome of Sutured Scleral-Fixated Intraocular Lens in Blunt and Penetrating Trauma in Children.

To determine the anatomical and functional outcomes of sutured scleral-fixated intraocular lens (SSFIOL) implantation in children with blunt and penetrating injuries to the eye. This is a retrospective, interventional case series study. Case records of children who underwent SSFIOL implantation in a tertiary eye care facility for traumatic aphakia, cataract, or subluxation were screened. Relevant data on demographics, visual acuity (VA) outcomes, and complications and their management were collected. Results for blunt and penetrating trauma were compared. There was stability or improvement of vision in 88.9% of eyes during the follow-up period. Young age at time of trauma (P = .031) and SSFIOL implantation (P = .002), history of retinal detachment (RD) before SSFIOL implantation (P = .019), poor preoperative best-corrected VA (BCVA) (P = .004), and development of RD in the follow-up period (P = .046) were independent risk factors for low final BCVA on univariate regression analysis. RD rate was 6.53% and was comparable in open and closed globe injuries. Intraocular lens (IOL) dislocation rate was 3.9%, and probability of survival was higher for open globe (0.78) as compared to closed globe (0.64) injuries (P = .042). SSFIOL implantation results in good VA improvement in both open and closed globe injuries. RD remains an important vision-threatening complication. IOL dislocation is more likely to occur in closed globe injuries. A prospective study evaluating the outcomes would better elucidate the role of these IOLs. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:757-764.].

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

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.

Results of scleral fixated intraocular lens implantation

Aim: To evaluate the results of scleral fixated intraocular lenses (SFIOLs) implantation in eyes that had lost capsular support. Material and methods: Eyes of twenty patients who had lost their capsular support due to various causes included in this study. This study involved 5 females and 15 males. Eight eyes were included following complicated cataract surgeries, five eyes were patients in trauma, three eyes were with subluxated intraocular lens, three aphakic eyes which underwent congenital cataract surgeries and one eye that had beginning of bullous keratopathy due to anterior chamber lens were operated. The secondary SFIOLs implantation were performed in all eyes. Preoperative and postoperative best corrected visual acuities were compared. Results: The mean age of patients was 61.4±15.04 years. The mean follow-up time was 3.12±0.7 months. The best corrected mean preoperative and postoperative visual acuities of patients were found as 0.16±0.02 and 0.38±0.07; respectively, using the Snellen chart. In our study; in two patients corneal edema, in one patient pupillary irregularity and in one patient increased intraocular pressure were observed. There was a statistically significant difference between the mean preoperative and postoperative visual acuities of patients according to the Wilcoxon test (p=0.01). Conclusion: SFIOLs implantation have still maintained its importance for correction of aphakia in patients without adequate capsular support despite all new developments.

APHAKIC CORRECTION USING RETROPUPILLARY IRIS CLAW LENS FOLLOWING A THERAPEUTIC KERATOPLASTY

Retropupillary iris claw lens implantation is a safe, simple, and effective alternative to anterior chamber or scleral-fixated intraocularlens implantation in post keratoplasty cases. We, hereby, report a case of retropupillary iris claw lens implantation for aphakiafollowing a therapeutic keratoplasty. A 55-year-old male who had a large fungal keratitis underwent therapeutic keratoplasty, andsubsequently, a retropupillary iris claw lens implantation. A 6-month follow-up showed a clear graft with stable iris claw lens andno comorbidities.

Vitreolensectomy combined with cyclophotocoagulation for the treatment of secondary glaucoma associated with traumatic lens luxation

Objective To evaluate the efficacy of pars plana vitreolensectomy combined with cyclophotocoagulation for the treatment of secondary glaucoma associated with traumatic lens luxation. Methods The data of 21 eyes of 21 cases with secondary glaucoma associated with traumatic lens luxation were collected and analyzed respectively.Patients received pars plana vitreolensectomy combined with cyclophotocoagulation, and among them 16 eyes combined with scleral fixated-intraocular lens implantation. The follow-up time was 6-18 months. The intraocular pressure (IOP), the number of anti-glaucoma medications, the position of intraocular lens and complications were observed. Results The postoperative IOP was significantly decreased(P=0.000). The average number of anti-glaucoma medications was significantly reduced after surgery (P=0.000). The cyclophotocoagulated ciliary processes were atrophied completely and the intraocular lenses were well-positioned. No complication associated with cyclophotocoagulation was observed. Conclusion Pars plana vitreolensectomy combined with cyclophotocoagulation is a practicable and safe procedure for secondary glaucoma associated with traumatic lens luxation. Key words: Glaucoma, secondary; Luxation, lens, traumatic; Cyclophotocoagulation; Vitreolensectomy, pars plana

Scleral fixated intraocular lens implantation with a modified Z-suture technique.

To evaluate visual outcomes and complications in scleral fixated intraocular lens (IOL) implantation with the modified Z-suture technique. Thirty-five eyes of 35 patients (20 male, 15 female) were included in the study. Patients underwent scleral fixated IOL implantation using the modified Z-suture technique and were followed in terms of visual acuity and complications. Mean postoperative follow-up time was 12.46±7.46months. Mean best corrected visual acuity was 1.35±0.91 logMAR preoperatively and 0.48±0.39 logMAR postoperatively, and difference was statistically significant (p<0.001). No suture-related complications were observed during follow-up in any of the patients. Slight infero-temporal dislocation of the IOL was observed at postoperative 5months in one patient (2.85%) who experienced blunt trauma. It caused no optical disturbance, and repeated surgery was not advised. Transient intravitreal hemorrhage was observed in two patients (5.7%) who underwent combined scleral fixation and pupilloplasty. The modified Z-suture technique is simple, fast, and was determined to be safe in terms of complications. However, long-term outcomes should be evaluated in larger patient groups.

Clinical manifestations of reverse pupillary block after scleral‐fixated intraocular lens implantation: Pre‐ and post‐laser peripheral iridotomy

PurposeTo present the clinical features and intraocular pressure (IOP) changes of patients with reverse pupillary block (RPB) after scleral fixated intraocular lens (IOL) implantation treated with laser peripheral iridotomy (LPI).MethodsA chart review of patients presenting with elevated IOP and RPB after sclera fixated IOL implantation was carried out. LPI was performed in 5 eyes of total 6 eyes included in the study. Ultrasound biomicroscopy (UBM) and Goldmann applanation tonometry (GAT) was also performed before and after laser treatment.ResultsFive men who underwent LPI at a mean of 38.2 months (range 9 to 75 months) after scleral‐fixated PC IOL implantation were included. Two patients had history of retinal detachment, one subject had a history of trauma, and one patient was previously diagnosed with open angle glaucoma. Angle recession was not observed in all cases. The mean axial length was 24.24 ± 1.14 mm (range 22.86 to 25.44). Scleral fixated IOL implantation with pars plana vitrectomy was performed in all cases. All eyes showed extremely deep anterior chamber with pigment (trace to 1 + ), a concave iris configuration and angle pigmentation before LPI. On UBM, all eyes showed RPB. After LPI, RPB was resolved on slit lamp examination and UBM in all cases. IOP decreased within normal range (from 29.00 ± 12.37 to 13.40 ± 2.88 mmHg, p = 0.043) temporarily, but IOP elevated again (to 30.20 ± 15.39 mmHg, p = 0.068) few weeks after LPI and all patients needed IOP lowering medications.ConclusionsLPI is effective for relieving the RPB. But, in some patients, IOP was still elevated and IOP lowering eye drops were needed persistently. Even though RPB is reloved, regular check up of IOP after LPI is recommended. Also it is necessary to consider the possibility of previously decreased TM function.

Rhegmatogenous retinal detachment in paediatric patients after pars plana vitrectomy and sutured scleral-fixated intraocular lenses.

PurposeTo report the incidence rate, management, and surgical outcomes of rhegmatogenous retinal detachment (RRD) in children who underwent pars plana vitrectomy (PPV) with sutured scleral-fixated intraocular lens implantation (SSFIOL).Patients and methodsOf the 279 eyes of 230 children who underwent PPV with SSFIOL at a tertiary eye care centre, 16 eyes of 15 children developed RRD. Retrospective analysis of the surgical details of RRD, the structural and functional outcomes was done.ResultsOf the 279 eyes of 230 children who underwent PPV with SSFIOL, RRD was seen in 5.7% of the eyes. Average age was 10.7 years (range 4-15 years). Indication for SSFIOL implantation was congenital subluxation of lens (8 eyes) and traumatic aphakia or lens subluxation (4 eyes each). PPV was done in 15 of the 16 eyes, and 1 patient underwent scleral buckling. Retina was attached at the last follow-up visit in 87.5% of the eyes with median number of surgeries being 1. BCVA at the time of retinal detachment, multiple surgeries, and PVR at presentation were associated with poor visual outcome.ConclusionSurgery for SSFIOL in our series of paediatric eyes was complicated by vision-threatening RRD in 5.7% of cases. Surgical outcome in eyes with RRD without PVR was better (100%) than that in those, where PVR had already set in (75%). Need for regular follow-up and self-monitoring of vision should be emphasized and discussed with the parents before surgical intervention.

A Comparative Study on Surgical Outcomes of Glued Intraocular Lens and Sutured Scleral Fixated Intraocular Lens Implantation

ABSTRACTPurpose: To compare the surgical outcomes of glued intraocular lens (GIOL) and sutured scleral fixated intraocular lens (SFIOL) implantation. Methods: A retrospective, interventional case series of 60 patients (68 eyes) who underwent GIOL (28 eyes: 11 primary; 17 secondary) and SFIOL (40 eyes: 24 primary; 16 secondary) in a tertiary eye care institute was done. The main outcome measures were complications, time taken for surgery, postoperative refractive outcomes, and final best-corrected visual acuity (BCVA). Results: The mean final BCVA was 0.42 (20/40) (+/– SD 0.29) in the GIOL group and 0.57 (20/50) (+/– SD 0.48) in the SFIOL group (p=0.08). The time taken for primary GIOL (mean+/– SD: 66+/–19 minutes) was significantly lower than primary SFIOL (means+/–SD: 94+/–34 minutes) (p=0.006). The complications were comparable between the GIOL (25%) and SFIOL (15%) groups (p=0.30). The most common complication noted was transient vitreous hemorrhage (GIOL 17%, SFIOL 5%). The only sight-threatening complication seen was retinal detachment, with one eye in each group. The mean follow-up was 20 (GIOL) and 20.4 weeks (SFIOL). Conclusion: Both glued intraocular lens and sutured scleral fixated intraocular lens are safe and effective procedures in cases of insufficient capsular support. In view of the shorter surgical time with similar outcomes, primary GIOL can be considered as a preferred surgical option over primary SFIOL.

High speed small gauge anterior vitrectomy cutter for scleral fixated intraocular lens implantation.

To report the outcomes of anterior vitrectomy using high speed cutter for scleral fixated intraocular lens (SFIOL) implantation in patients with posterior capsular rupture. Medical records of 51 patients with posterior capsular rupture who received high speed cutter anterior vitrectomy via limbal incision with SFIOL implantation from June 2011 to December 2013 were reviewed retrospectively for visual outcomes and complications. Totally 51 eyes of 51 patients were identified (23 males and 28 females). Mean age at surgery was 67.2±15y (range 27-91y), with mean follow-up of 23±8.2mo (range 12-40mo). The 49 (96.1%) eyes had improvement or unchanged of final postoperative visual acuity. The most common complication was vitreous haemorrhage (5.9%) and transient rise in intraocular pressure (5.9%) which all spontaneously resolved. High speed cutter anterior vitrectomy via limbal incision is a safe and effective method for those with posterior capsular rupture for SFIOL implantation.

Visual rehabilitation with secondary intraocular lens implantation in a case of hallermann–streiff syndrome

Hallermann–Streiff syndrome (HSS) is a rare congenital disorder with multiple abnormalities mainly affecting face, skull, hair, eyes, and teeth. We report a case of an 18-year-old Indian girl with HSS having typical physical features and ophthalmological manifestations. She had been operated for bilateral congenital cataract in her infancy, and since then, she had been aphakic in both eyes. She had poor vision in the right eye and irreversible blindness in the left eye. She underwent scleral-fixated (glued) intraocular lens implantation in the right eye with good visual recovery.

Toric markers-assisted implantation of the scleral-fixated intraocular lens.

To evaluate the efficacy of toric intraocular lens markers-assisted implantation of the scleral-fixated intraocular lens (SFIOL). From October 2010 to December 2013, all patients who had undergone secondary SFIOL implantation were assigned to group 1 and 2, in group 1 SFIOL was performed with the assist of radial keratotomy (RK)-marker, and in group 2 SFIOL was performed with the assisted of toric intraocular lens markers (T-and axis markers). Patients' demographic data and information on baseline preoperative visual acuity, indication for surgery and latest postoperative visual acuity were collected and analyzed. The haptic and optic positions were determined by ultrasound biomicroscopy. The optic tilt angle and decentration distance were measured. The study evaluated 43 eyes of 43 patients ranging in age from 3 to 66y. Group 1 comprised 24 eyes (24 patients) and group 2, 19 eyes (19 patients). Uncorrected reoperative acuity was improved on all the eyes postoperatively. The improved postoperative acuity was significantly more in group 2 than that in group 1 (1.11±0.38 vs 0.82±0.45 logMAR; F=4.85, P=0.03). Ultrasonic biomicrograph examination showed that the rate of haptic asymmetry was significantly higher in group 1 (42%, 10/24) than that in group 2 (11%; 2/19) (Chi square=3.68, P=0.04). The mean tilted degree in group 1 was significantly higher than that in group 2 (P=0.04). Mean decentration distance in group 1 was greater than that in group 2 (P=0.03). During SFIOL the toric markers help the surgeon identify the placement of fixation more precisely than that with the use of RK marker.

Trocar-Assisted, Sutureless, Scleral-Fixated Intraocular Lens Implantation Combined With Penetrating Keratoplasty.

To evaluate the results of trocar-assisted, sutureless, scleral-fixated (SSF) intraocular lens (IOL) implantation combined with penetrating keratoplasty (PKP). This study comprised 4 eyes (4 patients) undergoing trocar-assisted SSF-IOL implantation during PKP. The combined technique was performed in 3 eyes of 3 patients with bullous keratopathy and in 1 eye with central corneal opacity. Two eyes had anterior chamber IOL implants, and 2 were aphakic. All eyes had inadequate capsular support. Evaluated parameters were biomicroscopy, corrected distance visual acuity, intraocular pressure, IOL position, and corneal graft status. Intraoperative and postoperative complications and additional surgeries were recorded. The mean follow-up period was 28.3 ± 3.5 months. Trocar-assisted SSF-IOL implantation with PKP was successfully performed in all eyes. Visual acuity improved in all patients. During the follow-up period, a well-stabilized IOL without any IOL-related complication was obtained in all eyes. In one eye with corneal scarring and aphakic glaucoma caused by trauma, drug-resistant glaucoma developed 6 months after surgery requiring Express glaucoma shunt surgery. In one eye with a history of central retinal vein occlusion, repeat keratoplasty was performed after 10 months because of graft rejection. Trocar-assisted SSF-IOL implantation combined with PKP is an alternative method for visual rehabilitation in the eyes with bullous keratopathy and corneal scarring without sufficient capsular support.

Use of the anterior chamber maintainer in secondary scleral-fixated posterior chamber intraocular lens implantation for aphakia after traumatic surgery

Objective To evaluate the effect and safety of secondary scleral-fixated posterior chamber intraocular lens (PCIOL) implantation using an anterior chamber maintainer for aphakia after traumatic surgery. Methods Thirty-four eyes of 34 cases with aphakia after traumatic surgery were subjected to scleral-fixated PCIOL using an anterior chamber maintainer. The clinical effect and the complications were observed 3 months to 18 months after the operation. Results All operations were performed successfully. There was no complication such as epichoroidal hemorrhage, anterior chamber collapse or intraocular lens dislocation. After 3-18 months follow-up, visual acuity was at ≤0.1 in 3 eyes, 0.12~0.3 in 11 eyes, 0.4~0.5 in 7 eyes and ≥0.6 in 10 eyes. The difference between post-and pre-operative best corrected visual acuity was not statistically significant (P>0.05). Conclusion Secondary scleral-fixated PCIOL implantation using an anterior chamber maintainer is effective to correct aphakia after trauma and provides favorable visual outcomes with low complication rate. Key words: Maintainer, anterior chamber; Lens, intraocular; Aphakia, traumatic

Comparison of sutured versus sutureless scleral-fixated intraocular lenses

To compare the intermediate-term anatomic and visual results of scleral-fixated intraocular lens (IOL) implantation using 4-point suture fixation or transscleral sutureless fixation. Tertiary referral eye care center in South India. Retrospective case series. Medical records of consecutive patients who had scleral-fixated IOL surgery from January 1, 2010, to March 31, 2014, with more than 1 year of follow-up were retrospectively analyzed. Indication for scleral-fixated IOL implantation was aphakia after cataract extraction or trauma. The surgical technique was based on individual surgeon preference. The uncorrected distance visual acuity (UDVA), previous surgery, type of trauma, surgical technique, and complications were analyzed. One hundred nine cases were analyzed. The mean follow-up was 18.9 months ± 8.7 (SD). The majority of eyes experienced an improvement in UDVA after surgery; 93 eyes (86%) had a Snellen equivalent corrected distance visual acuity of 6/12 or better. The baseline characteristics and final visual outcomes in the sutured scleral-fixated IOL group (n = 52) and sutureless scleral-fixated IOL group (n = 59) were comparable. Patients with previous trauma (n = 52) were predominantly men and were significantly younger than those in the cataract group. The visual and refractive outcomes were comparable between eyes with previous trauma and eyes with previous cataract surgery. Transient cystoid macular edema was the most common complication (12%); retinal detachment occurred in 5 cases (4.5%). Scleral-fixated IOLs provided excellent visual rehabilitation of aphakic eyes without capsular support. The sutured technique and sutureless technique appear to be equally good in eyes with aphakia after cataract surgery or trauma. No author has a financial or proprietary interest in any material or method mentioned.

Modified technique for transscleral fixation of posterior chamber intraocular lenses

BackgroundSuture exposure remains to be a potential problem of transscleral fixated posterior chamber intraocular lens (PCIOL). We report a modified technique to minimize the risk of suture exposure for the transscleral fixation of PCIOL.MethodsThe modified surgical technique is as following: at first, two 3 mm × 4 mm square scleral pockets were created from groove incisions at opposite positions. A straight needle attached to a 10–0 polypropylene suture was passed through one incision groove. Then, a 27-Gauge hollow needle passed through the opposite sclera incision bed was used to retrieve the straight fine needle via its barrel. The sutures were tied to themselves after one more bite on the scleral bed. At last, the suture ends were left long (about 4 mm) and laid flat into corresponding laminar scleral pockets. This modified technique of PCIOL was performed in 48 post-traumatic aphakic vitrectomized eyes from 48 patients (47 male, one female) with mean age of 34.8 ± 14.8 years. Main outcome measures included best corrective visual acuity (BCVA), IOL decentration, IOL tilt, and postoperative complications.ResultsThe mean follow-up was 32.3 ± 10.8 months (3–67 months). The LogMAR BCVA remained stable, from a preoperative value of 0.46 ± 0.34 to postoperative 0.44 ± 0.34 (p = 0.69). Mild IOL tilt (5–10°) was observed in five eyes, and slight IOL decentration (0.5–1.0 mm) was seen in three cases. No case of suture exposure, suture breakage, IOL dislocation, or endophthalmitis was observed during the follow up period.ConclusionThe modified technique allowed stable placement of PCIOLs in post-traumatic aphakic eyes with a wide range of follow-up. Our procedure might have the potential benefit to avoid suture exposure in scleral-fixated IOL implantation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12886-015-0118-8) contains supplementary material, which is available to authorized users.

Comparison of Outcomes of Primary Anterior Chamber Versus Secondary Scleral-Fixated Intraocular Lens Implantation in Complicated Cataract Surgeries

To compare the outcome of primary anterior chamber vs secondary scleral-fixated intraocular lens (IOL) implantation in complicated cataract surgeries. Retrospective, comparative study. A consecutive series of complicated cataract surgeries with primary anterior chamber (ACIOL) or secondary scleral-fixated IOL implantation from January 1, 2004 to December 31, 2009 was analyzed. Main outcome measures included the postoperative best-corrected visual acuity (BCVA) and postoperative complications. There were 89 eyes in the primary ACIOL group and 74 eyes in the secondary scleral-fixated IOL group. The mean follow-up duration was 64.1 ± 36.7 months. The mean postoperative logarithm of minimal angle of resolution (logMAR) BCVA at 1 year was 0.32 ± 0.54 and 0.34 ± 0.21 in the primary ACIOL group and the secondary scleral-fixated IOL group, respectively (P = .734). The mean latest logMAR BCVA was 0.68 ± 0.54 and 0.61 ± 0.47 in the primary ACIOL group and the secondary scleral-fixated IOL group, respectively (P = .336). The primary ACIOL group had more early postoperative complications (P < .001). No difference in late postoperative complications was observed between the 2 groups (P = .100). Regression analysis showed that primary ACIOL and secondary scleral-fixated IOL implantation had similar latest postoperative logMAR BCVA (P = .927), while the presence of late complications was associated with a worse final visual outcome (P = .000). This study shows that there are no long-term differences in the visual outcomes and complication profiles after primary ACIOL or secondary scleral-fixated IOL implantation in a complicated cataract operation when capsular support is inadequate.