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Comparison of different surgical techniques for secondary intraocular lens implantation for aphakia without capsular support

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Session Details

Session Title: Presented Poster Session: FLACS & Others

Venue: Poster Village: Pod 1

First Author: : S.Chiu UK

Co Author(s): :    K. Spiteri-Cornish              

Abstract Details

Purpose:

To compare the visual and refractive outcomes and complication rates for various surgical techniques used in secondary intraocular lens (IOL) implantation for aphakia without capsular support, therefore not suitable for sulcus or in-the-bag implantation.

Setting:

A single tertiary centre in Sheffield, UK, which receives vitreoretinal cases from South Yorkshire.

Methods:

This was a retrospective review. Patients between October 2014-October 2016 inclusive were identified from Medisoft, our electronic clinical record system, by searching for “secondary IOL”, “scleral-fixed IOL”, “ectopia lentis”, and “pseudophakic – IOL dislocated/subluxed”. Patients were included if they received a secondary IOL in the setting of aphakia without capsular support. The following data was collected: demographics; diagnosis; ocular co-morbidities; pre- and post-operative visual acuity (VA); post-operative complications; and refractive outcome. Vision was recorded in Snellen and converted to logMAR with conversion charts. A paired t-test (p<0.05) was used to compare outcomes.

Results:

Of the 179 eyes identified, 64 eyes (62 patients) were suitable for analysis. Forty (62.5%) received ACIOL, 13 (20.3%) scleral-fixated sutured IOL, and nine (14.1%) scleral-fixated non-sutured IOLs. Two (3.1%) received iris-clipped IOL, and they were excluded from analysis. Baseline ocular co-morbidities affecting VA were present in 83.9%. There was no statistically significant difference in post-operative VAs (0.52, 0.65, 0.678), refractive deviation from desired outcome (1.275, 0.675, 0.92), or astigmatism (+1.55, +2.45, +3.38). However, values for astigmatism were were higher with non-sutured scleral-fixated IOL. The commonest complication was CMO (15-30%). There were no documented cases of endophthalmitis.

Conclusions:

Many different techniques exist for secondary IOL implantation without capsular support, and the choice largely depends on surgeon preference and expertise. ACIOLs were generally carried out in older patients (> 60 years of age). Visual and refractive outcomes and complication rates were comparable in our three groups. Visual outcomes were affected by ocular co-morbidities at baseline (present in more than 75% of cases), and by post-operative complications including macular oedema and high astigmatism.

Financial Disclosure:

NONE

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