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First Author: Tahir KansuBozkurt TURKEY
Co Author(s): Mustafa Gurkan Erdogan Betül Onal Cihan Unlu
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To evaluate clinical results of sutureless implantation of a 3-piece foldable posterior chamber intraocular lens (IOL) to aphakic eyes with vitrectomy history using intrascleral fixation method
: Retrospective, consecutive case series
Twenty eyes of 20 patients which were aphakic and previously vitrectomized underwent secondary lens implantation with sutureless intrascleral fixation technique. All eyes were with insufficient capsular support. Present technique included two scleral tunnels with 25 G trocar system with aid of anterior chamber maintainer. IOL was injected through a 3 mm clear corneal incision. Haptics of the IOL were passed through these tunnels with 25 G forceps and tied within the sclera to enhance stabilization with 8.0 vicryl sutures and IOL. Preoperative and postoperative visual acuities, keratometry values and postoperative spherical equivalents as well as complications in the follow-up period were evaluated.
Mean age of the 20 patients (13 male,7 female) was 65,4 ± 19,1 years and mean follow-up time was 8,2 ± 4,7 months. Mean preoperative LogMAR visual acuity with aphakic spectacles(0.76 ± 0.39) increased to 0.48 ± 0.33(with spectacles) following intrascleral IOL implantation. Mean postoperative spherical equivalent was -1.00 ± 0.9 D. There was no statistically significant difference between preoperative and postoperative mean keratometry values ((p=0.12), keratometry values: 42.74 ± 1.7 and 43.2 ± 2, respectively). Mean lenticular (depending on the IOL) astigmatism at the 3rd postoperative month was 0.55 ± 0.35 (0-1.25)D. Intraocular haemorrhage was the most common complication, but for all eyes, haemorrhage was smooth and disappeared within 1st postoperative month. In terms of the stabilization of the IOL, 19 eyes maintained stable fixation during follow-up time. However, one patient experienced dislocation of IOL on the 10th postoperative month after the procedure and IOL was re-implanted with the same procedure with double tying of haptics in the sclera. There were no cases of recurrent dislocation, endophthalmitis, retinal detachment, or glaucoma. Corneal decompensation was seen in an eye with history of post-operative endophthalmitis following complicated cataract surgery. Three eyes developed cystoid macular edema in the 3rd postoperative month.
Secondary intrascleral implantation of a three-piece posterior chamber IOL may be suggested as a preferable method for visual rehabilitation in aphakic, previously vitrectomized eyes. In the present study, injection of a foldable IOL through a clear corneal small incision also contributed the favourable visual outcome with less surgical-induced astigmatism. In addition, lenticular astigmatism which may be a great deal of problem for the current technique was found to be at acceptable levels. FINANCIAL INTEREST: NONE