Outcomes and Complications of Sutured Scleral-Fixated Foldable Intraocular Lens Implantation: A Retrospective Study of 5-Year Follow-Up

Abstract

Purpose. To evaluate long-term outcomes and complications of sutured scleral-fixated foldable intraocular lens (IOL) implantation. Design. Retrospective study. Methods. Patients who underwent sutured scleral-fixated foldable IOL implantation using 10-0 polypropylene suture were followed up for at least 5 years at one Chinese tertiary hospital and two primary hospitals. Results. 52 eyes among 48 patients (35 male and 13 female) were evaluated. The mean age (years) was 50.27 ± 20.08 (range: 6 to 81). The mean postoperative follow-up time (months) was 79.70 ± 18.84 (range: 60 to 121). The mean best-corrected visual acuity (BCVA) improved from 0.83 ± 0.69 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.50 ± 0.45 logMAR at the last follow-up visit. There was improved or unchanged BCVA in 44 eyes (84.62%) and reduced BCVA in 8 eyes (15.38%). Mild intraoperative intravitreal hemorrhage was observed in 3 eyes (5.77%). Early postoperative complications included transient elevated intraocular pressure (IOP) in 5 eyes (9.62%) and hypotony in 1 eye (1.92%). Secondary epimacular membrane occurred in 5 eyes (9.62%) and retinal detachment (RD; 3 years postsurgery), subconjunctival suture knot exposure (5 years postsurgery), and persistent elevated IOP (in a GRAVES patient) occurred in 1 eye (1.92%) each. No suture erosion or breakage nor IOL dislocation was observed. No visually threatening IOL tilt or decentration was reported in any patient. Conclusion. Sutured scleral-fixated foldable IOL implantation demonstrated satisfactory long-term outcomes and rare suture-related complications. This technology was safe and did not require complicated equipment and is of considerable interest in the setting of aphakia without adequate capsule support.

Long-term risk of suture breakage after scleral fixation of late in-the-bag intraocular lens dislocation with a polypropylene 10-0 suture

“…30,31 Other studies on scleral suturing of the IOL without the surrounding capsule have shown similar, lower or higher rates of suture breakage compared with our study, but most of these studies have a short follow-up or included fewer eyes. 10,11,15,32,33 Yu et al observed no suture breakage in their study with a minimum of 5 years of follow-up, but they only included 52 eyes. 33 Studies by Luk et al and Kokame et al had larger sample sizes, and the frequency of suture breakage was 1.9% (n = 104) and 0.47% (n = 118), respectively, although with considerable variation in follow-up.…”

“…10,11,15,32,33 Yu et al observed no suture breakage in their study with a minimum of 5 years of follow-up, but they only included 52 eyes. 33 Studies by Luk et al and Kokame et al had larger sample sizes, and the frequency of suture breakage was 1.9% (n = 104) and 0.47% (n = 118), respectively, although with considerable variation in follow-up. 11,32…”

Intraocular lens dislocation: manifestation, ocular and systemic risk factors

“…IOL implantation in the sulcus with and without optic capture has the lowest complication rate and best visual acuity outcome [ 27 ]. Scleral fixation is often used in complex or traumatic cases without adequate capsule support, when other options are not feasible [ 28 , 29 ]. Iris-claw lenses have gained more and more popularity over the last years with the advantages of small learning curve and low complication rates [ 30 ].…”

Visual Outcomes of Secondary Lens Implants in Children with Different Etiologies

“…Yu and Maxwell observed favorable longer-term findings and few complications after sutured scleral-fixated foldable lens implantation. Their procedure is safe, does not need complex equipment and can correct aphakia in the absence of adequate capsule support [29,30].…”