Visual And Refractive Outcomes Of Trocar-Assisted Sutureless Three-Piece Intraocular Lens Scleral Fixation

The purpose of this study was to evaluate the visual and refractive outcomes of trocar-assisted sutureless three-piece intraocular (IOL) scleral fixation.

Villa Igea OPF Forlì

This retrospective study included patients who underwent trocar-assisted three-piece IOL fixation for aphakia or dislocated IOL. Two 25-gauge or 27-gauge trocars were placed 2 mm posterior to the limbus at 2 and 8 o’clock creating 2 mm antiparallel scleral tunnels. Following pars plana vitrectomy, a three-piece IOL was injected into the anterior chamber andthe haptics were pulled out of the scleral tunnels. An ophthalmic cautery device was used to create a flange at the tip of the haptic. Outcome measures were best corrected visual acuity (BCVA), change in endothelial cell density (ECD),refractiveprediction error and complications.

13 eyes of 13 patients were included. BCVA significantly improved at 3 months after surgery (from 0.43 ± 0.32 to 0.14± 0.13 logMAR, p=0.014), with61.5% patients reaching a BCVA ≥ 20/25.Mean ECD decreased from 2145 ± 420 to 2056 ± 531 cells/mm²(p=0.173). Prediction error was 0.26 ± 0.72 D, with 76.9% of eyes achieving a prediction error within ± 1.0 D and 53.8% of eyes within ±0.5 D. Postoperative complications were transient ocular hypertension in 1 eye (7.7%), cystoid macular edema in 1 eye(7.7%)and IOL dislocation requiring repeat surgery in 1 eye (7.7%).

Trocar-assisted sutureless three-piece IOL scleral fixation provides good visual outcomes and low rates of postoperative complications. The predictability of refractive outcomes is lower than thatachieved in standard in-the-bag IOL implantation, with a tendency towards a hyperopic refractive surprise.