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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
Author(s) -
Czajka Marcin Piotr,
Frajdenberg Agata,
Stopa Marcin,
Pabin Tomasz,
Johansson Björn,
Jakobsson Gunnar
Publication year - 2020
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.14307
Subject(s) - medicine , pars plana , aphakia , vitrectomy , ophthalmology , surgery , fixation (population genetics) , intraocular lens , visual acuity , retrospective cohort study , sclera , population , environmental health
We present a literature review of surgical techniques of intraocular lens placement in eyes with insufficient capsular support, focusing on the most recent publications, together with a retrospective multicentre consecutive case series analysis of 103 eyes undergoing pars plana vitrectomy and sutureless intrascleral ( SIS ) fixation of a standard three‐piece PCIOL . Many different approaches appear in the literature without any specific procedure achieving superior outcomes. Advantages and disadvantages vary between techniques. Common complications related to IOL fixation techniques were as follow: anterior chamber IOL : transient/permanent corneal oedema (9–66.6%), uveitis (1.1–39.3%); iris‐fixated IOL : pupil ovalization (16–47.7%); and sutured scleral‐fixated IOL : suture breakage/exposure (6.1–11%), vitreous haemorrhage: (5.5–16.6%). In our retrospective case series, indications for surgery were postoperative aphakia in 50 eyes (49%), IOL dislocation in 38 eyes (37%) and natural lens dislocation in 15 eyes (14%). Scleral tunnels for haptic fixation were created with (28 eyes, 27.2%) or without (75 eyes, 72.8%) 25 gauge trocar cannulas. Complications included transient hypotony ( n = 20; 19.4%), corneal decompensation ( n = 7; 6.7%), IOL dislocation ( n = 6; 5.8%), cystoid macular oedema ( n = 5; 4.8%), vitreous haemorrhage ( n = 4; 3.8%) and retinal detachment ( n = 4; 3.8%). Mean best corrected visual acuity improved from log MAR 0.65 to 0.36 at the final visit (p = 0.001). In conclusion, SIS fixation provides good anatomical and functional outcomes; however, complications can occur. The number of surgical approaches for IOL dislocation described in the literature indicates that optimal treatment remains to be found.