Visual Outcomes And Vitreomacular Safety Of Scleral-Fixated Intraocular Lenses In Complex Eyes: A Multi-Center Analysis Of 38 Cases

To evaluate the clinical outcomes and safety profile of scleral-fixated intraocular lenses (SFIOL) in complex eyes, specifically those with prior vitrectomy or complicated cataract surgery. While SFIOL techniques have evolved, the anatomical challenges of the vitrectomized globeremain a concern for stability. This study analyzes 38 patients to determine the impact of trans-scleral manipulation on the vitreomacular interface (VMI) using OCT to monitor for cystoid macular edema (CMO). By comparing functional visual rehabilitation (BCVA) and complication rates across two surgeons, we aim to validate the refractive predictability and posterior segment safety of scleral fixation in high-risk surgical scenarios.

This multi-center retrospective study was conducted across three UK institutions: Western Eye Hospital, Maidstone Hospital, and Frimley Park Hospital. Data were collected from 38 consecutive cases performed by two experienced surgeons over a four-year period. The cohort consisted of eyes undergoing scleral-fixated IOL implantation for aphakia or IOL dislocation, following complicated cataract surgery or trauma, all of whom underwent concurrent or prior pars plana vitrectomy.

A retrospective review of 38 eyes was performed. The primary surgical technique was four-point scleral fixation using an Akreos lens with Gore-Tex sutures (n=31, 82%), followed by intrascleral tunnel fixation (n=7, 18%). All eyes were vitrectomized. Primary endpoints included the change in Best-Corrected Visual Acuity (BCVA) in LogMAR and the incidence of post-operative Cystoid Macular Edema (CMO) confirmed via SD-OCT. A preliminary refractive analysis (Mean Absolute Error, MAE) was conducted on a subset of patients (n=7) with stable post-operative refraction.

The mean pre-operative BCVA was 1.22+/- 0.77 LogMAR, which improved significantly to 0.43 +/-0.29 LogMAR post-operatively (p < 0.001). Post-operative CMO was identified in 11 eyes (28.9%), with a higher prevalence noted in patients with prior retinal detachment or trauma. Other complications included corneal decompensation (n=3) and transiently raised intraocular pressure (n=2). In the refractive subset (n=7), the Mean Absolute Error was 0.80 +/- 0.72 D, indicating acceptable predictability despite the anatomical complexity of these eyes. No cases of IOL dislocation or suture-related erosions were noted during the follow-up period.

Scleral-fixated IOL implantation, particularly the four-point Akreos technique, provides effective visual rehabilitation in complex, vitrectomized eyes. While the incidence of post-operative CMO remains a notable consideration in this high-risk population, the significant gain in functional vision and the stability of the fixation techniques support its use as a primary approach for aphakia management in tertiary centers.