Outcomes of Transscleral Two-Point Fixation Versus Closed Continuous-Loop Four-Point Fixation of Intraocular Lens in Subluxated Lens Secondary to Marfan Syndrome

Abstract

Introduction To compare the outcome of two different transscleral fixation approaches for posterior chamber intraocular lens (IOL) implantation, a two-point fixation of the Sensar (Allergan) or CZ70BD (Alcon) IOL and a four-point fixation of the Akreos Adapt (Bausch & Lomb) foldable IOL, for treatment of subluxated lenses in Marfan syndrome (MFS). Methods Fifty-three eyes of 33 consecutive patients with subluxated lenses secondary to MFS were studied. Eighteen patients with MFS (30 eyes) received two-point fixation of the Sensar (16 patients, 26 eyes) or CZ70BD (2 patients, 4 eyes) IOL, and 15 patients with MFS (23 eyes) received four-point fixation of the Akreos Adapt IOL. Preoperative and postoperative ophthalmologic examinations were performed. A primary outcome measure of postoperative complication was studied. Results The mean preoperative best corrected visual acuity (BCVA) in the two-point group was 0.68 ± 0.38 logarithm of the minimum angle of resolution (logMAR), and it improved to 0.30 ± 0.32 logMAR at the final follow-up ( p < 0.05). The mean preoperative BCVA in the four-point group was 0.68 ± 0.45 logMAR, and it improved to 0.28 ± 0.28 logMAR at the final follow-up ( p < 0.05). The BCVA results did not differ significantly between groups. The intraocular pressure was increased at the final follow-up in the two-point group ( p < 0.05). Transscleral two-point fixation of IOL has relatively high incidences of pupillary capture of the IOL. Conclusion The closed continuous-loop transscleral four-point fixation of the Akreos Adapt foldable IOL is more suitable than two-point fixation of a two-haptic IOL in treating subluxated lenses due to MFS.

Long-term outcome of Transscleral Four-Point Fixation of Akreos Intraocular Lens with Closed Continuous-Loop Suture

“…23 There is only one article published by our institution that compares the outcome of two different transscleral fixation techniques and found that transscleral two-point fixation of IOL has relatively high incidences of pupillary capture of the IOL, and no pupillary capture was seen in all cases of transscleral four-point fixation of the Akreos IOL. 5 More studies that directly compare the effectiveness of transscleral two-point fixation and four-point fixation of posterior IOLs are needed. In our research, no pupillary capture of the IOL occurred.…”

“…[1][2][3][4] Different techniques of transscleral fixation of PC IOLs have been described, such as two-point fixation and four-point fixation. 5,6 Transscleral two-point fixation of IOL has relatively high incidences of pupillary capture of the IOL. 7,8 For ophthalmologists, the ideal transscleral fixation technique should be simple, quick, minimally invasive, safe, and effective and should offer easy management of potential surgical complications.…”