First Author: S.Chiu UK
Co Author(s): K. Spiteri-Cornish
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To compare the visual and refractive outcomes and complication rates for various surgical techniques used in secondary intraocular lens (IOL) implantation for aphakia without capsular support, therefore not suitable for sulcus or in-the-bag implantation.
A single tertiary centre in Sheffield, UK, which receives vitreoretinal cases from South Yorkshire.
This was a retrospective review. Patients within the last 24 months (October 2014-October 2016 inclusive) were identified from Medisoft, our electronic clinical record system, by searching for “secondary IOL”, “scleral-fixed IOL”, “ectopia lentis”, and “pseudophakic – IOL dislocated/subluxed”. The patient list was reviewed, and patients were included if they received a secondary IOL in the setting of aphakia without capsular support. The following data was collected: demographics; diagnosis; ocular co-morbidities; pre- and postoperative visual acuity (VA); postoperative complications; and refractive outcome, including spherical equivalent, deviation from desired refractive outcome, and astigmatism. Vision was recorded in Snellen and converted to LogMAR with conversion charts. A paired t-test (p<0.05) was used to compare outcomes.
Of the 179 eyes identified, 64 eyes (62 patients) were suitable for analysis. Forty (62.5%) received ACIOL, 13 (20.3%) received scleral-fixated sutured IOL, and nine (14.1%) received scleral-fixated non-sutured IOL. Two (3.1%) patients received iris-clipped IOL, and they were excluded from analysis due to low numbers. Mean ages were 77.9 years in the ACIOL group, and 57.7 years and 54.4 years in the scleral-fixated groups (sutured and non-sutured, respectively). At baseline, ocular co-morbidities affecting VA were present in 83.9%. There was no statistically significant difference in postoperative VAs (0.52, 0.65, 0.678), refractive deviation from desired outcome (1.275, 0.675, 0.92), or astigmatism (+1.55, +2.45, +3.38). However, values for astigmatism were higher with non-sutured scleral-fixated IOL due to the smaller corneal incision used. The commonest complication for each surgical technique was cystoid macular oedema (15-30%). There were no documented cases of endophthalmitis.
Many different techniques exist for secondary IOL implantation without capsular support, and the choice largely depends on surgeon preference and expertise. ACIOLs were generally carried out in older patients (> 60 years of age). Visual and refractive outcomes and complication rates were comparable in our three groups. Visual outcomes were affected by ocular co-morbidities at baseline (present in more than 75% of cases), and by postoperative complications including macular oedema and high astigmatism.