1 Year Surgical Outcomes and Safety of Combined Trans Pars Plana Vitrectomy with Iris Fixated Posterior Chamber Intraocular Lens for Subluxated Intraocular Lens and Cataracts

Abstract

Importance/Background: To describe the characteristics and 1-year postoperative surgical outcomes of primary combined trans pars plana vitrectomy (TPPV) with iris-fixated posterior-chamber intraocular lens (IF-PCIOL) implantation for subluxated cataracts and intraocular lenses (IOLs). Methods: Consecutive cases of significantly subluxated cataracts and IOLs from January 2014 to May 2019 were included in this retrospective case series. Results: A total of 103 eyes of 103 patients were included. Median age was 67.4 (interquartile range [IQR] 27-89) years. Thirty-two (31.1%) had subluxated cataracts, while 71 (68.9%) had subluxated IOLs. Overall median preoperative logMAR BCVA was 0.9 (IQR 0-2.5). Median logMAR BCVA improved to 0.3 (0-1.9) and 0.2 (0-1.8) for the subluxated cataract and IOL groups, 81.2% and 75% of eyes achieved logMAR ≤ 0.3, and 94% and 97% achieved IOL stability at month 12, respectively. Eyes with subluxated IOLs had a significantly less myopic median SE if a new IOL was implanted compared to irisfixating the dislocated IOL. Conclusion: Combined primary TPPV and IF-PCIOL implantation is a good surgical option for subluxated IOL or cataract without sufficient capsular support, with at least 75% achieving logMAR BCVA ≤ 0.3 and 95% IOL stability at postoperative year 1. In eyes with subluxated IOLs, explanting that IOL and iris-fixating a new IOL led to a reduced SE and better visual outcome at postoperative month 12 when compared to iris-fixating the dislocated IOL.

Clinical and Anatomic Outcomes of 3-Piece Poly(methyl methacrylate) Intraocular Lens Rescue and Needle-Assisted Transconjunctival Intrascleral Lens Fixation

“…Iris fixation can be complicated by secondary pigment dispersion, intraocular hemorrhage, and elevated intraocular pressure (IOP). [4][5][6] IOL exchange with an anterior chamber IOL (ACIOL) is a well-established technique; however, precise IOL sizing, corneal endothelial cell loss (ECL), and the need for a large incision to perform the exchange convey clear surgical disadvantages.…”

Risk Factors and Surgical Approach for Pars Plana Vitrectomy of Posteriorly Dislocated Intraocular Lenses

“…IOL dislocation early (3 months) after the cataract surgery is mainly caused by surgically induced or preexisting zonular dehiscence. On the other hand, IOL dislocation at the later stages ( 6-9 years after surgery)is caused by ocular trauma or progressively weakening zonules (Foo et al, 2021;Kristianslund et al, 2017). Iatrogenic lens dislocation can be caused by intravitreal injection leading to vitreous prolapse; in some cases, no risk factor is identified (Kristianslund et al, 2021).…”