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Refractive outcome of trocar-assisted sutureless scleral fixation of 3-piece intraocular lenses

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First Author: F.Esen TURKEY

Co Author(s):    V. Aykut   F. Sali   H. Oguz              

Abstract Details

Purpose:

Intraocular lens (IOL) implantation with trocar-assisted sutureless scleral fixation technique is relatively new IOL implantation approach for aphacic eyes. In this surgery, the haptics of a 3-piece IOL is buried inside the scleral tissue and this placement of the haptics can change the position of the optic of the IOL, which can also alter the refractive outcome. The aim of this study was to evaluate the refractive outcome of this surgery.

Setting:

Istanbul Medeniyet University Goztepe Education and Research Hospital

Methods:

The files of 22 patients who had a 3-piece IOL (Alcon Akrisoft MA60AC) implantation with trocar-assisted sutureless scleral fixation technique were retrospectively reviewed and the patients were invited for examination. IOL power was calculated with optical biometry (Lenstar LS900). We expected the position of the implanted IOL to be close to the level of the capsular bag. Therefore, we did the IOL power calculations according to the formulas designed for in the bag IOL implantation (SRK-T for normal eyes, Hiagis for long eyes, and Hoffer-Q for short eyes). The final refractive error was determined with an autorefractometer (Topcon KR-1/RM-1).

Results:

Fourteen patients (8 male, 6 female, mean age: 62.7 ±18.7) volunteered for the study. Preoperative LogMAR BCVA was 1.74±1.16 and postoperative LogMAR BCVA was 0.76±1.16 (p=0.06). There was no significant difference between preoperative and postoperative corneal astigmatism values (p=0.16). There was also no significant difference between the postoperative corneal and total astigmatism values (p=0.44), confirming the absence of significant IOL tilt. The difference of the implanted IOLs from the calculated IOL power for emmetropy was 0.09±0.49D (p=0.52). Despite targeting emmetropy, the refractive outcome shifted to hyperopia +0.83±1.30D and was significantly different from the refractive status calculated with Lenstar (p=0.034).

Conclusions:

In the management of aphacic patients, placement of an IOL to the ciliary sulcus or fixation of a sutured IOL to the sclera leads to a more anterior positioning of the IOL compared to the capsular bag and causes a myopic shift. However, intrascleral fixation of the IOL leads to a different position of the IOL optic (more posterior compared to the capsular bag) and causes a hyperopic shift. Therefore, we believe that target refractive value should be around -1.00 D compared to in-the-bag IOL position in order to overcome the hyperopic shift.

Financial Disclosure:

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