Sutureless scleral-fixated posterior chamber intraocular lens: choosing the right patient

Session Details

Session Title: Free Paper Session 13: Vitreoretinal Surgery IV

Session Date/Time: Friday 08/09/2017 | 14:30-16:00

Paper Time: 15:06

Venue: Room 117

First Author: : N.Vila CANADA

Co Author(s): :    M. Kapusta                             

Abstract Details

Purpose:

To report clinical outcomes and contributory factors to the postoperative visual acuity in sutureless scleral-fixated posterior chamber intraocular lenses (PCIOL) implantation.

Setting:

Single-centre retrospective review – Jewish General Hospital (McGill University, Quebec, Canada).

Methods:

Patients who underwent sutureless scleral fixation of three-piece PCIOL (Alcon MA60AC) and pars plana vitrectomy ± endoscopy-guided vitrectomy (E2 MicroProbe™; EndoOptiks, Little Silver,USA) between July 2015 to January 2017 were included. The indications for this technique were the following: aphakia, subluxated and dislocated IOLs. Postoperative Ultrasound Biomicroscopy (UBM) was performed to measure: anterior chamber depth, horizontal ciliary sulcus, optic tilt and haptic location. Postoperative refraction at 1 month postop was used to measure spherical equivalent.

Results:

Seventeen eyes of 17 patients were included. The mean participant age was 73 ± 14 years old and 58.9% (n=10) were females. The follow up median was 7 months (range, 3 -17 months). There were 2 aphakic eyes, 3 subluxated PCIOLs and 12 dislocated PCIOLs. The IOLs were fixed and centreed in 88.2% of the eyes. Two were re-dislocated and required re-intervention, both patients had a spherical equivalent of >6.00 diopters and axial length >26.5 mm. The postoperative refractive error range was -0.75 diopters to +2.75 diopters (spherical equivalent). In 74.3% of the patients, best corrected visual acuity (BCVA) was ≥ 20/40. The IOL optic tilt measured was absent in patients with BCVA between 20/30-20/20. The mean horizontal ciliary sulcus measurement was 11,81 ±0,85 mm, no differences were seen between groups when compared patients with ≥ 20/40 vs <20/40 (p>0.05). When residual capsular support was not removed in subluxated IOLs it was observed a trend to present better VA (66.7% vs 33.3%; p>0.05). Iris-IOL contact was seen in one eye. In two patients the IOL’s haptics were identified in the ciliary processes. When endoscopy-guided vitrectomy was performed (n=3), none of the haptics were in contact with the ciliary body.

Conclusions:

Sutureless intrascleral PCIOL fixation technique provides stable IOL when secured with scleral tunnels. Endoscopy –guided vitrectomy is a helpful tool to ensure safer haptic positioning. The absence of optic tilt is associated with better visual acuity in our series. Patients with pathologic myopia seem to have poorer IOL stability.

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