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Comparison of surgical outcomes of lens replacement vs rescue for sutureless intrascleral tunnel fixation of dislocated intraocular lenses

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First Author: J.Ma CANADA

Co Author(s):    M. Benson   M. Tennant   S. Lapere              

Abstract Details

Purpose:

In eyes with dislocated posterior chamber intraocular lenses (IOL), one common surgical technique is to implant a scleral-fixated IOL. When scleral fixation is performed as a secondary procedure, the lens may be either replaced or rescued. While IOL rescue is less invasive and more cost-effective, there is limited evidence to directly compare the effectiveness and safety of these two techniques. We aim to compare the visual outcomes and post-operative complication rates between IOL replacement versus rescue in a cohort of patients undergoing secondary sutureless scleral fixation.

Setting:

All participants underwent surgery with one of five vitreoretinal surgeons at the Royal Alexandra Hospital in Edmonton, AB, Canada.

Methods:

Retrospective cohort study of 179 eyes with a dislocated posterior chamber IOL that underwent secondary sutureless intrascleral tunnel IOL fixation between January 2014 and January 2017. The pre-existing lens was either re-used or replaced with a new 3-piece IOL based on surgeon preference. All patients received at least six months post-operative follow-up. Pre- and post-operative best-corrected visual acuity were recorded at two and six months. Post-operative complications, anti-inflammatory drop requirements, and indications for subsequent surgery, if any, were documented.

Results:

The analysis included 111 eyes, of which 78 eyes underwent IOL replacement and 33 eyes underwent IOL rescue. The mean pre-operative visual acuity (logMAR) was 1.23. At six months, the mean visual acuity for IOL replacement was 0.75 and for IOL rescue was 0.77 (p=0.90). Post-operative complications occurred in 38% of patients for IOL replacement and in 42% for IOL rescue. At six months, anti-inflammatory drops were required in 18% of those who underwent IOL replacement and in 25% for IOL rescue. Subsequent surgery was indicated in 29% of patients for IOL replacement and in 36% for IOL rescue.

Conclusions:

There is no statistically significant difference between IOL replacement and rescue in terms of post-operative visual outcomes for eyes undergoing secondary sutureless scleral fixation. However, there may be a slight benefit for replacing the existing IOL as it appears to be associated with lower rates of post-operative complications, anti-inflammatory drop use, and requirement for subsequent surgery. Given these results, both IOL replacement and rescue are reasonable options for the sutureless scleral fixation technique.

Financial Disclosure:

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