Implantation of scleral‐fixated posterior chamber intraocular lenses in adults

Abstract

ABSTRACT.Purpose: To report the results of transscleral fixation of posterior chamber intraocular lenses in adults. Methods: We carried out a retrospective analysis of 91 eyes of 81 patients who underwent implantation of posterior chamber lenses with transscleral sutures between 1997 and 2006. The mean age of the patients was 62 years (range 19-94 years). Sixty-eight eyes (74.7%) were aphakic at the time of surgery. In 10 patients (11.0%) an intracapsular cataract extraction and in six patients (6.6%) a pars plana lensectomy was performed prior to the fixation of the posterior chamber intraocular lens. In seven eyes (7.7%) a previously implanted IOL was removed. The mean follow-up was 36 months (range 6-116 months). Results: The mean preoperative best corrected visual acuity (BCVA) was 0.37 (range counting fingers to 1.0), which improved to 0.5 (range light perception to 1.0) postoperatively. At the end of follow-up, BCVA was unchanged or improved in 81 eyes (89.0%), reduced by 2 Snellen lines in four eyes (4.4%), and between finger counting and light perception in four eyes (4.4%). The most serious complication was suprachoroidal haemorrhage, which occurred in two eyes. Retinal detachment occurred in three eyes, all of which successfully reattached after surgery. Suture erosion or spontaneous dislocation caused by suture degradation or breakage was not seen. Conclusions: Secondary implantation of posterior chamber intraocular lenses with transscleral fixation is a reasonably safe procedure in adults, with relatively few serious complications. Even in patients with longterm follow-up, suture breakage was not seen.

Anterior segment optical coherence tomography findings of reverse pupillary block after scleral-fixated sutured posterior chamber intraocular lens implantation

“…Kjeka et al 12 report 3 eyes (3.3%) that developed wound leakage and required resuturing. We usually use a single interrupted 10-0 nylon suture in the middle of 6.0 mm scleral tunnel incisions.…”

Primary and secondary implantation of scleral-fixated posterior chamber intraocular lenses in adult patients

“…Implantation of an anterior chamber intraocular lens (ACIOL) is associated with a relatively high rate of complications 4567. Several reports concerning scleral-fixated posterior chamber intraocular lenses (PCIOL) have been reported with mostly favorable results 4891011. However, the surgical technique of scleral-fixated PCIOL insertion is more technically demanding 111213.…”

“…Several reports concerning scleral-fixated posterior chamber intraocular lenses (PCIOL) have been reported with mostly favorable results 4891011. However, the surgical technique of scleral-fixated PCIOL insertion is more technically demanding 111213. Histological studies of the anterior segment showed that the best position in these eyes is sulcus fixation 1415.…”

Retropupillary fixation of subluxated flexible intraocular lens by suturing through the optical part of the lens and iris

“…We were concerned that a hemorrhage could occur during surgery because the needle passes beneath the iris unseen (without visualization) and can puncture the well-vascularized ciliary body, 1,14 as well as endophthalmitis later because of the erosion of the conjunctiva by the sutured haptic. 1,2,11 We decided against the iris-claw IOL because later dislocation of this IOL is possible due to disenclavation, 8,10,14 and we wanted to reimplant the original IOL. After fixating the IOL with 2 nonabsorptive sutures (10-0 polypropylene), we hoped that no tearing would occur later with dislocation of the IOL, which occurs occasionally with iris-claw IOLs.…”