Safety and efficacy of current scleral fixation methods for intraocular lenses (IOLs)

Session Details

Session Title: Cataract Surgery Complications

Session Date/Time: Monday 16/09/2019 | 16:30-18:00

Paper Time: 17:06

Venue: Free Paper Forum: Podium 2

First Author: : D.Muth GERMANY

Co Author(s): :    T. Kreutzer   A. Wolf   M. Shajari   S. Priglinger   W. Mayer                 

Abstract Details

Purpose:

Evaluation of currently three most-common IOL sclera fixation techniques (1) Prolene® suture scleral-fixation technique (Hoffmann pocket) (2) GoreTex® suture four point fixation technique (3) flanged intrascleral IOL fixation double-needle technique (“Yamane” technique).

Setting:

Ongoing prospective clinical study at the Department of Ophthalmology of the Ludwig-Maximilians-University, Munich, Germany.

Methods:

Sixty eyes (n=60) of 59 patients were so far included in this ongoing study. Best-corrected visual acuity (BCVA), manifest refraction (OR), corneal tomography (Oculus Pentacam), biometry (Zeiss IOL Master 700), macular thickness in optical coherence tomography (Heidelberg Engineering Spectralis-OCT), IOL type and power were recorded before and at least 6 months after IOL sclera fixation surgery. Statistical evaluation about pre-/post-surgery differences were calculated and analyzed using Wilcoxon-test and regression models (IBM SPSS).

Results:

Patients with IOL refixation (45,7%), IOL exchange (15,2%), secondary IOL implantation due to aphakia (34,8%), primary IOL implantation (4,3%) were included. Reasons for IOL sclera fixation included trauma (11,9%), previous surgery (14,3%), abnormal zonula fibers (i.e. PEX) (16,7%), congenital aniridia (4,8%). Sclera fixation using a Prolene® was done in 45,0% of the patients, GoreTex® in 25,0%, “Yamane” in 30%. At follow-up most of the patients showed a centered IOL, while 13% presented with decentration and IOL tilt needing refixation. There was no statistical difference between pre- and post-surgery BCVA and macular thickness changes.

Conclusions:

IOL revision cases are increasing with also an increasing number and age of pseudophakic patients. In complicated cases surgical options are limited to iris or sclera fixated IOLs. With additional iris abnormalities, sclera fixation is often the only option. All three evaluated sclera fixation methods showed high safety but a small amount of revision rates in a long-term observation period. Visual outcome was not statistically different compared to pre-surgery, meaning a visual rehabilitation to the status pre-surgery is possible. However, compared to iris fixated IOLs, sclera fixation is surgically more complex and shows a steeper learning curve for the surgeon.

Financial Disclosure:

None