Glued intraocular lens in eyes with deficient capsules: retrospective analysis of long-term effects

Abstract

Purpose: To assess the long-term (6-12 years) results and complications of glued transscleral-fixated intraocular lens (IOL). Setting: Dr. Agarwal's Eye Center, Chennai, India. Design: Retrospective case series. Methods: Eyes with glued IOL of more than 5-year follow-up were evaluated. Visual acuity (logarithm of the minimum angle of resolution [logMAR]), IOL tilt, corneal topography, corneal endothelial cell density, intraocular pressure, central corneal thickness, central foveal thickness, and ocular residual astigmatism (ORA) were evaluated. Results: Overall, 91 eyes (63 patients) with mean postoperative 8.2 ± 2.3 years were analyzed. The duration was 10 to 12 years in 31 eyes (34%), 9 years in 14 eyes (15.3%), and 6 to 9 years in 46 eyes (50.5%). No subscleral haptic was visible in 50% eyes. Mild, moderate, and severe grade of haptic visibility was noted in 33.5%, 9.4%, and 7%, respectively. The corrected distance visual acuity (CDVA) was 0.50 ± 0.50 logMAR. Clinically, no tilt was seen in 87 eyes (95.6%), whereas detectable tilt was seen in 4 eyes (4.3%). The optical coherence tomography microtilt was 0.8 ± 1.7 and 0.4 ± 1.2 degrees in 90- and 180-degree axes, respectively. The mean iris vault was 0.45 mm, and the mean ORA was 1.10 ± 1.00 diopter. Complications were glaucoma (7.6%), IOL luxation (4.4%), retinal detachment (3.2%), macular edema (4.3%), corneal decompensation (3.2%), uveitis (2.1%), and uveitis–glaucoma–hyphema syndrome (1%). Haptic reposition (3.2%), retinal detachment surgery (3.2%) keratoplasty (1%), pupilloplasty (2.1%), and IOL explantation (1%) were the second surgeries performed. Conclusions: Glued IOL has shown good anatomical and functional stability with minimal incidence of vision-threatening complications on long-term.

One Year Outcomes and Stability of a Novel Scleral Anchored Intraocular Lens

“…Furthermore, no cases of IOL decentration or dislocation occurred during the whole follow-up. These results apparently compare favorably with those previously reported for sutured [ 25 ] and glued [ 26 ] scleral-fixated IOL. However, comparative studies are warranted to assess whether SSF IOL stability is superior to other techniques of IOL scleral fixation.…”

Scleral-fixated intraocular lens implants—evolution of surgical techniques and future developments

“…Durak et al [144] reported a mean tilt of 6.09 + 3.80 degrees in 53 patients who underwent transscleral sutured PCIOL; decentration >1 mm and optic tilt >10 degrees was present in 16.7% of cases. Analysis with anterior segment OCT scans following glued SFIOL has shown a mean optic microtilt of 0.8 + 1.7 degrees on the vertical axis and of 0.4 + 1.2 degrees on the horizontal axis in 20% of cases, with minimal decentration [118]. After sutureless flanged technique described by Yamane et al [1] mean IOL tilt was reported to be 3.4 + 2.5 degrees.…”

“…Additionally, achieving a steady postoperative position of the IOL will ensure a stable refractive status in the long run. For example, any changes in the structures providing an anchor point for the IOL implant, such a loss of tensile strength of surrounding tissues or sutures, will determine the effective position and mechanical stability of the lens [118].…”

“…Regarding transscleral IOL fixation with fibrin glue, Kumar et al [118] recently reported long-term refractive outcomes in 91 eyes of 63 patients with capsular deficiency after at least 5 years of follow-up. Hydrophobic acrylic lenses were used in 94.5%, and the remaining corresponded to PMMA lenses.…”

“…For example, implementation of one or more eyelets per haptic and enlargement of haptic ends aid to minimise rate of slippage and IOL dislocation [134]. Haptic visibility through the sclera or conjunctiva has been described in 50% of cases after glued IOL technique by Kumar et al [118]. However, most of these are considered as not clinically significant in the absence of rubbing of the haptic tip.…”