Secondary Scleral-fixated Intraocular Lens Research Articles

Factors predicting redislocation or suture-break in eyes after scleral-fixated intraocular lens.

To investigate predictive factors for redislocation in patients with recurrent intraocular lens (IOL) dislocation following secondary scleral-fixated IOL (SFIOL) surgery. Two tertiary referral hospitals. Retrospective case series. Patients undergoing SFIOL surgery were grouped into redislocation and no-redislocation groups. Medical records of consecutive patients who underwent SFIOL surgery between June 2014 and December 2019 at two tertiary referral centers were reviewed. Data regarding patient demographics, treatment factors, anatomical and functional outcomes, and postoperative complications were recorded. We included 237 eyes of 225 patients (169 [75.1%] men). The redislocation group was more likely to have a younger mean age at the initial SFIOL surgery (redislocation vs no-redislocation, 55.4 vs 62.0 years, respectively; P=0.008), have a prior history of a previous suture-break (23 eyes, 52.3% vs 1 eye, 0.5%; P<0.001), and have undergone the initial SFIOL surgery using <1 mm-sized side-port incisions (17 eyes, 38.6% vs 32 eyes, 16.5%; P=0.002) than was the no-redislocation group. Additionally, the redislocation group had a higher occurrence of complications (P<0.001). Multivariable regression revealed that younger age, left eye involvement, aphakic status prior to the surgery, unremarkable primary IOL dislocation cause, need for ocular hypertension treatment and glaucoma surgery, and no large incision during the initial surgery were significantly (all P<0.05) associated with redislocation. Younger age, left eye involvement, postoperative complications like ocular hypertension and glaucoma, and techniques without large incisions increase the risk of redislocation. Conversely, lower risk factors include unremarkable surgery causes and a history of aphakic conditions.

Recurrent scleral-fixated intraocular lens dislocation with spontaneous repositioning produced by tilting and head movements

Introduction: An unusual case of a patient who could repeatedly reposition his dislocated sulcus poly(methyl methacrylate) intraocular lens (IOL) by head movements and tilting his body is reported. Patient and clinical findings: An 86-year-old man presented with a 3-year history of recurrent episodes of transient blurred vision and monocular diplopia in his left eye. 20 years previously, he had phacoemulsification cataract surgery complicated by posterior capsule tear, which was treated with anterior vitrectomy and a secondary scleral-fixated IOL. Over the previous 3 years, he had recurrent episodes of IOL dislocation. He could regain normal vision by tilting his head and trunk. The dislocated IOL was maneuvered into position by capturing the haptic into the residual capsular remnant by appropriate head movements. On examination, his corrected distance visual acuity (CDVA) was counting fingers, and the posterior chamber IOL was subluxated inferiorly. During presentation, he could not reposition it himself, warranting a surgical intervention. Diagnosis, intervention and outcomes: He underwent suturing of the IOL in the sulcus. The IOL was well-centered with a CDVA of 6/9. Conclusions: To the authors’ knowledge, this is the first case report of a patient who could repeatedly reposition a dislocated IOL through tilting and head movements.

Angle-supported intraocular lens versus scleral-sutured posterior chamber intraocular lens in post-cataract surgery aphakic patients: two-year follow-up cost-effectiveness analysis.

To compare visual, anatomical and economical outcomes of patients with secondary anterior chamber intraocular lens (AC-IOL) implantation and secondary scleral fixated intraocular lens (SF-IOL) implantation. In this retrospective observational study, 38 aphakic patients after complicated phacoemulsification divided in two groups, AC-IOL group (17 patients receiving AC-IOL implantation) and SF-IOL group (21 patients receiving SF-IOL implantation). Corrected distance visual acuity (CDVA), patient reported visual outcome (VF-14) and endothelial cell density (ECD) were measured at baseline and two-year follow-up. Complication rate was registered. The global cost of each procedure and the incremental cost-effectiveness ratio (ICER) were calculated. No statistically significant difference was found in CDVA (logMAR 0.24 ± 0.17 vs. 0.32 ± 0.26, p = 0.27), VF-14 (68 ± 18 vs. 61 ± 20, p = 0.24), ECD (1456.48 ± 525.15 vs. 1341.71 ± 374.33, p = 0.48) and overall complication rate (p = 0.79) postoperatively between the SF-IOL group and the AC-IOL group. The ECD loss rate was significantly higher in the AC-IOL group (15.5% vs. 3.5%, p = 0.004). The average global cost of the two procedures was higher in the SF-IOL group (p < 0.005) and ICER showed an additional payment of 693 € for each patient in SF-IOL group against a saving of 186 endothelial cells 2 years postoperatively. AC IOL and SF-IOL implantation showed similar outcomes in terms of visual function and safety profile. Higher ECD loss was found in AC-IOL group. The global cost of implantation was significantly lower for AC-IOL, but the ICER seems to justify the SF-IOL implantation in patients with low ECD.

A Study of Anatomical and Visual Outcome in Secondary Scleral Fixated Intra-Ocular Lens Implantation

Abstract:&#x0D; Aims: To study of anatomical and visual outcome in secondary scleral fixated intra-ocular lens implantation&#x0D; Settings and Design: Hospital based prospective case study conducted at a tertiary care centre over a period of 2 years.&#x0D; Methods and Material: 30 eyes of 30 patients underwent secondary scleral fixation of IOL by 2-point Ab-externo technique. Post-operatively best corrected visual acuity, IOP, Keratometry and complications encountered were noted at regular follow-up of 7th day, 6 weeks, 3 months and 6 months.&#x0D; Results: Mean age of patients in the study was 52.33 years in the range of 46-60 years. Out of the 30 cases, 56.66% were men and 43.33% were women. Best corrected pre-operative V/A was in the range of 6/24 to 6/18 (53.33%), 6/12 to 6/9 (16.66%), 6/60 to 6/36 (30%). At final follow-up of 6 months, the results were, 63.33% in range of 6/12 to 6/9, 26.66% in 6/24 to 6/18 and 10% in 6/60 to 6/36. In early complications, transient corneal oedema was seen in 20%, transient IOP elevation in 10%, while vitreous haemorrhage and post-operative hyphaema was noted in 3.33% each. In late complications, Cystoid Macular Oedema was seen in 10%, pupil distortion was seen in 6.66% of patients and decentred IOL was seen in 3.33% of the patients.&#x0D; Conclusion: Secondary scleral fixated IOL provides good visual outcome and better anatomical position with minimal complications.

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.

Scleral-fixated intraocular lens implantation in unilateral aphakic children

Objective To assess the feasibility of scleral-fixated intraocular lens (IOL) implantation as an alternative form of optical correction in aphakic children intolerant of contact lenses and whose anterior segments lack capsular support. Design Prospective, noncomparative case series. Participants A total of 11 eyes of 11 unilateral aphakic children in the age group 4 to 9 years (mean, 6.45 years) were included in the study. Intervention Secondary scleral-fixated IOL implantation was performed in all cases. The patients underwent anterior vitrectomy at the time of IOL implantation. Amblyopia therapy in the form of patching was given post-IOL surgery. The follow-up ranged from 4 to 18 months (mean, 10.90 months). Main outcome measures Postoperative best-corrected visual acuity (BCVA) in comparison to preoperative visual status and complications from the procedure were analyzed. Results Postoperative BCVA remained within 1 Snellen line of the preoperative visual status in six eyes, or 54.5% of patients; it improved by more than 1 Snellen line in three eyes, or 27.2% of patients, and decreased by more than 1 Snellen line in two eyes, or 18.1% of patients. The complications encountered were suture erosion through the conjunctiva in two eyes (18.18%), marked postoperative anterior chamber reaction in two eyes (18.18%), IOL decentration in one eye (9.09%), glaucoma in one eye (9.09%), and cystoid macular edema in one eye (9.09%). Conclusion Secondary scleral-fixated IOL implantation was successful in achieving BCVA comparable to preoperative BCVA. However, a longer follow-up is required to document any further complications.