Scleral fixation of dislocated 1-piece IOL without IOL explantation or intrascleral sutureless 3-piece IOL fixation: making the right surgical decision

Session Details

Session Title: Moderated Poster Session: Cataract
Session Date/Time: Friday 15/02/2019 | 14:00-15:00
Paper Time: 14:08
Venue: Poster Area


First Author: I.Tzamichas GREECE
Co Author(s): A. Papazacharia  C. Keskini  E. Karasavvidou  C. Kampos  D. Balatsoukas     

Abstract Details

Purpose:

To present the outcomes of two different scleral fixation procedures in aphakic and pseudophakic patients and highlight the significance of the patients’ phakic status in making the right surgical decision.

Setting:

Department of Ophthalmology, Hippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece

Methods:

Retrospective consecutive series of 22 patients, who underwent intraocular lens (IOL) scleral fixation after complicated phacoemulsification surgery. Patients were either aphakic or had dislocated IOLs. For all the aphakic patients an intrascleral sutureless 3-piece IOL fixation was performed, whereas those with dislocated IOL underwent transscleral fixation of the dislocated 1-piece IOL without IOL explantation. Evaluated parameters were: follow-up period, visual acuity (VA), refractive error and intraocular pressure (IOP) (all evaluated pre- and postoperatively), postoperative complications (retinal detachment, malpositioned IOL, secondary glaucoma, vitreous hemorrhage, postoperative hyphaema, cystoid macular edema (CME)).

Results:

7 out of 22 patients were aphakic (group A) and 15 presented with dislocated IOL(group B).For group A mean VA improved from HM to 0,8. Short-term complications included elevated IOP (n=1) and CME (n=1). Long-term complications included visually insignificant IOL tilt (n=1). For group B mean VA improved from 0,05 to 0,63. Short-term complications included elevated IOP (n=1) and CME (n=2). Long-term complications included visually insignificant IOL tilt (n=3). No serious ocular (group A/B) or suture-related (group B) complications were detected during the follow-up period.

Conclusions:

Surgical management of dislocated IOLs remains a challenging clinical problem. While intrascleral sutureless 3-piece IOL fixation is an established surgical procedure for patients with aphakia or dislocated IOLs, transscleral fixation of dislocated one-piece IOLs without their explantation appears to be an efficient and safe procedure for pseudophakic subjects. The technique is time-and cost-efficient, requires less surgical maneuvers without the need of IOLs explantation and results in favorable long-term visual outcomes with low complication rates. Therefore, intrascleral sutureless 3-pieceIOL fixation should always be considered in aphakia, whereas transscleral fixation of previously dislocated one-piece IOLs is a favourable alternative for pseudophakic patients.

Financial Disclosure:

None