Secondary intraocular lens implantation: a large retrospective analysis

Abstract

PurposeTo investigate preoperative ocular risk factors and indications for secondary intraocular lens (IOL) implantation and compare postoperative complications, visual and refractive outcomes in a tertiary referral center.MethodsPatients older than 14 years that underwent secondary IOL implantation and had a minimum follow-up of 3 months were enrolled in this retrospective case series. Preoperative ocular risk factors, indications for surgery, postoperative complications, and visual and refractive outcomes including prediction error (PE) and absolute error (AE) were evaluated. IOLs were fixated in following positions: anterior chamber (AC), retropupillary iris-claw (IC), sulcus, and capsular bag or sclera.ResultsOne-hundred eighty-two eyes of 174 patients with mean follow-up of 17 ± 13.6 months were evaluated. Leading cause for surgery was IOL dislocation (75%), followed by secondary aphakia (19%) and IOL opacifications (6%). Previous vitrectomy was the major preoperative ocular risk factor (43%). Mean corrected distance visual acuity improved from preoperative 0.68 ± 0.55 to 0.42 ± 0.31LogMAR by the last follow-up (p = 0.001). PE and AE differed highly depending on the indication for surgery (p = 0.041 and p = 0.008, respectively) and the IOL fixation (p = 0.011 and p = 0.028, respectively), with IC-IOLs showing the lowest PE and AE. Postoperative AC-hemorrhage occurred mainly after IC-IOLs (p = 0.003), and postoperative hypotony was significantly higher in eyes with previous uveitis (p = 0.026).ConclusionsPrevious vitrectomy seems to be a major underreported risk factor in eyes that undergo secondary IOL implantation. Refractive outcomes depend on indication for surgery and fixation type, with retropupillary IC-IOLs providing the best refractive results, though not statistically significant compared to other IOL positions.

Outcomes and complications of iris-fixated intraocular lenses in cases with inadequate capsular support and complex ophthalmic history

“…If combined PPV cases and cases with a history of PPV were excluded, the re-subluxation rate would be 2/45 (4.4%). Our findings support the recent observation made by Vounotrypidis et al that vitrectomy is a major underreported risk factor for IOL re-subluxation [ 31 ]. All eyes in our study were surgically managed.…”

Sutureless intrascleral fixation using different three‐piece posterior chamber intraocular lenses: a literature review of surgical techniques in cases of insufficient capsular support and a retrospective multicentre study

“…; Vounotrypidis et al. ). In summary, the most common complications after ACIOL placement included transient corneal oedema, bullous keratopathy, increased IOP, uveitis and hyphema (Chan et al.…”

“…; Weene ; Vounotrypidis et al. ). Zeh & Price () speculate that the stable fixation of ACIOL in the angle depends on the size of the ACIOL.…”

“…Recently, Vounotrypidis et al. () found in a large retrospective study of secondary intraocular implantation that 50% of patients were operated with angle‐supported ACIOL, with outcomes not inferior to iris‐claw IOL (IC‐IOL) or scleral fixation. Other recent studies of secondary IOL implantation showed that ACIOLs were used in 23.5–42% of cases (Lorente et al.…”

Novel use of an adjustable single 8–0 polypropylene suture of scleral fixation without conjunctival dissection

“…Transscleral suture-mediated IOL fixation was first described by Malbran in 1986 [2], and is a relatively common surgical approach owing to its low incidence of postoperative complications. Prior studies have described certain suture-related complications associated with this approach, including inflammation, suture erosion, and suture degradation [3,4]. Efforts to prevent these complications have employed approached including the rotating of suture knots into the eye and covering suture ends with scleral pockets or flaps [5][6][7][8][9].…”