Comparative analysis of corneal versus scleral tunnel incision implantation of anterior artisan Aphakia intraocular lens

Abstract

Purpose: To evaluate the surgically induced astigmatism (SIA), efficacy and safety of two distinct accesses for anterior Artisan Aphakia IOL implantation in patients without capsular support. Methods: Outcome data were collected for all patients who had undergone prepupillary Artisan Aphakia IOL insertion associated with pars plana vitrectomy from October 2016 and June 2022 at Puerta de Hierro‐Majadahonda University Hospital. All those with available preoperative and postoperative IOL master keratometry records were included in the analysis. The results were analysed by the incision type (corneal versus scleral tunnel). Results: Ninety‐seven eyes from 79 patients were included. Average follow up was 2 years. Forty‐five (48%) were corneal incisions and 53 (52%) were scleral tunnels. The main causes were: 33 (32%) eyes with Marfan syndrome, 27 (26%) eyes had a complicated cataract surgery and 23 (23%) eyes had luxation or subluxation of the IOL‐capsule complex. The mean surgically induced astigmatism (SIA) in the scleral tunnel group (1.28 ± 1.15 diopter [D]) was significantly lower than in the corneal incision group (2.20 ± 1.27 D) (p < 0.001). The mean BCVA was better in the scleral tunnel group (0.18 ± 0.33 logMAR) than in the corneal incision group (0.27 ± 0.53 logMAR), although the difference was not significant (p = 0.09). The rate of complications did not show differences between groups. Two eyes (2%) developed corneal decompensation. There were 20 (20.67%) cases of cistoid macular edema (11 in the scleral tunnel group and 10 in the corneal incision group). In the scleral tunnel group, there was a tendency to first day postoperative hypotonia (24.5%) (p = 0.06), in all cases it resolved with conservative measures within 1 week. Conclusions: Scleral‐incision approach is a safe technique that should be performed for anterior Artisan Aphakia IOL implantation in order to reduce SIA and improve BCVA. Intraocular pressure should be monitored throughout the first postoperative week.