Session Title: Vitreoretinal Surgery II
Session Date/Time: Friday 12/09/2014 | 14:30-16:00
Paper Time: 15:34
Venue: Boulevard C
First Author: : P.Susvar INDIA
Co Author(s): : C. Rao A. Maheshwari
Scleral fixated intraocular lens (SFIOL) is one of the feasible option for rehabilitating the aphakic eyes where conventional capsule supported IOLs cannot be placed. Many techniques and approach for fixation of the SFIOL have been discussed in the literature in regard to the ease, safety and stability of the IOL. The purpose of this study is to highlight the various indications for the surgery and the visual outcomes. The study also attempts to discuss the pre-conditions necessitating additional steps during the surgery and various early and late postoperative complications.
Medical Research Foundation, Tertiary eye referral centre
It is a retrospective case series. 100 eyes of 96 patients operated for SF IOLs over a period of four years were analysed. Patients above 18 years were included with a minimum follow-up of 6 months. Detailed ophthalmic examination was done with digital biometry for A-scan and IOL power was calculated. The technique of ab externo 4-point scleral fixation was performed for all the patients by two surgeons. Complete vitrectomy was done and ancillary procedures were performed depending on the indications and intraoperative situation. SF IOL was fixated and secured to the scleral bed using polypropylene sutures.
100 eyes of 96 patients were analysed (72 men). The mean age of the patients was found to be 46 years (range 18 to 76 years). Mean follow-up was 23.5 months (range 6 to 73.93 months). Indications for surgery included traumatic subluxation/dislocation (34%), aphakia due to previous surgeries (31%) and IOL dislocation (15%). 17% of the eyes underwent planned vitrectomy with SFIOL. 46% of eyes required belt buckle to support the vitreous base along with cryotherapy /laser photocoagulation to treat the retinal lesions, 15% of the eyes underwent only SFIOL. 67% patients having preoperative VA < 20/200 improved to VA >20/40 at last follow up(p 0.025). 53.8% patients having preoperative VA between 20/200 to 20/40 improved to VA >20/40 at last follow up (p 0.025). 63.5% eyes had uneventful early post operative period. Of the remaining, 26.3% eyes had increased IOP and 21.1% eyes had residual minimal vitreous bleed. At 6 weeks follow up, 25% eyes had increased IOP, 16.7% eyes had retinal detachment and 16.7% had cystoid macular edema. 77% eyes had no complications at last follow up. Out of the remaining, 27.3% eyes had increased IOP, 13.6% had optic capture.
Scleral fixated IOL is a safe and favourable option for wide range of indications. The indications in this study favour towards the management of vitreoretinal pathology. All the cases required complete vitrectomy, with a good vitreous base excision. Certain additional surgical steps were needed intraoperatively like supporting with belt buckle, cryo and laser treatment for retinal lesions. These situations prefer a vitreo-retinal surgeon to operate and manage the cases better. Early and late postoperative complications were managed without need for re-surgery except for the cases having retinal detachment. SFIOLs provide a favourable visual outcome in majority of cases in this series.