Scleral Iol Fixation After Filtration Glaucoma Surgery – A Retrospective Case Series

To examine lens position and intra, -and postoperative complications of different techniques of scleral-fixated intraocular lens (sfIOL) implantation combined with filtration glaucoma surgery in glaucoma patients.

Retrospective case series

Patients who underwent sfIOL implantation using the 4-flanged (4F), the Carlevale technique (CT) or the Yamane technique (YT) after lens subluxation without capsular support were retrospectively analyzed. Postoperative lens tilt and decentration were measured using anterior segment optical coherence tomography (AS-OCT, Casia2, Tomey). IOL master 700 (Zeiss) was used for axial length measurements and calculation of target refraction. Retrospective chart review included time between filtration surgery and sfIOL implantation, intraocular pressure (IOP), target refraction (TR) and postoperative spherical equivalent (SE) including calculation of the absolute difference (AD).

10 eyes of 10 patients were included. Mean age was 77.9 years. 9 patients had pseudoexfoliation syndrome, one congenital glaucoma. Mean follow-up after sfIOL implantation was 5 months with mean lens tilt and decentration of 8.51±5.9° and 0.58 ±0.4mm, respectively. 4F fixation was performed in 5 eyes, CT in 4 eyes and YT in 1 eye. 8 patients underwent sfIOL implantation after filtration surgery (trabeculectomy:8,shunt:2) with a mean of 7.7 years between both surgeries. 2 patients underwent combined sfIOL and microshunt implantation. Mean TR was -1.22±0.71D with mean AD to postoperative SE of 0.5±0.41D. IOP remained within target between 8-13mmHg in 7 eyes after trabeculectomy. IOP elevation requiring additional surgery occurred in 1 eye.

Three sfIOL techniques were successfully performed in eyes with previous filtration glaucoma surgery. Peritomy is not necessary for haptic fixation in the 4F and YT, minimazing potential intraoperative complications. Fixation in the horizontal axis as provided by both, the CT and 4F, can further decrease the risk of haptic-bleb interference between the superiorly postitioned filtration bleb and the sfIOL haptics. Lens tilt and decentration, as well as refractive outcomes were comparable to the standard sfIOL population.