Scleral-Fixated Intraocular Lenses

Abstract

Intraocular lenses (IOLs) can have inadequate support for placement in the capsular bag as a result of ocular trauma, metabolic or inherited conditions such as Marfan’s syndrome or pseudoexfoliation, or complicated cataract surgery. Surgical options for patients with inadequate capsular support include alternative placement in the anterior chamber (ACIOLs), fixation to the iris, or fixation to the sclera. The surgical techniques for each of these approaches have improved considerably over the last several decades resulting in improved visual and ocular outcomes. If no capsular or iris support exists, the surgeon can fixate an IOL to the sclera or the patient can remain aphakic. IOLs can be fixated to the sclera using sutures or by tunneling the IOL haptics into the sclera without sutures. This review summarizes the pre-operative considerations, surgical techniques, outcomes, and unique complications associated with implantation of scleral-fixated IOLs.

Scleral-Fixated Intraocular Lens: Indications and Results

“…When facing an aphakic eye with no capsular support, the IOL can be placed in the anterior chamber, fixated to the iris (in its extreme or mid-periphery) or fixated to the sclera. The surgical techniques in all of these approaches have improved considerably over the last decades with subsequent optimization of visual and ocular outcomes [3].…”

“…Ideal correction of aphakia means the placement of the intraocular lens (IOLs) in the bag which relies on good capsular support [1][2][3]. In these circumstances, IOL is well centered to the pupillary axis, maximizing the chances of optimal surgical and refractive outcomes [2].…”

“…In the absence of adequate posterior capsular support, like in complicated cataract surgery with disruption of the posterior capsule, it is often possible to place the IOL in the sulcus with excellent visual outcome [1,3].…”

“…Addressing this situation can be managed in several ways, like anterior chamber (ACIOLs), iris-fixated (IFIOLs), and scleral-fixated (SFIOLs) [2,3]. Choosing the best technique in the absence of capsular support can be challenging, although all these variants proved to have similar benefits and risks [2,3].…”

Results of scleral fixated intraocular lens implantation

“…Especially, in patients who has a shallow anterior chamber or corneal disease such as Fuch's corneal distrophy, corneal edema, or a corneal transplant SFIOLs may be the preferred option. (6) In this study, we aimed to evaluate the results of SFIOLs in eyes without capsular support due to various reasons.…”