Long-term outcome of scleral-fixated intraocular lens implantation without conjunctival peritomies and sclerotomy in ocular trauma patients

Abstract

Background To investigate the long-term outcomes and complications of scleral-fixated intraocular lens (SFIOL) implantation without conjunctival peritomies and sclerotomy in patients with a history of ocular trauma with inadequate capsular support during primary pars plana vitrectomy or silicone oil removal. Methods Records of ocular trauma patients who underwent implantation of SFIOL without conjunctival peritomies and sclerotomy during primary pars plana vitrectomy or silicone oil removal. Results Sixty-nine eyes of 69 patients were included in this study. The median follow-up period was 34 months (range, 6–99 months). The average patient age at the time of surgery was 44 years old (range, 4–80 years). At the end of follow-up, the preoperative mean of best corrected visual acuity (BCVA) was 0.79 ± 0.86 log of the minimum angle of resolution (logMAR), which improved 0.20 ± 0.26 logMAR postoperatively ( P = 0.01). BCVA improved or remained unchanged in 64 eyes (92.8%), VA decreased two lines in five eyes (7.2%). Early postoperative complications included transient corneal edema in seven eyes (10.1%), minor vitreous hemorrhage in four eyes (5.8%), transient elevated intraocular pressure (IOP) in one eye (1.4%), and hypotony in three eyes (4.3%). Late postoperative complications included persistent elevated IOP in five eyes (7.2%), epiretinal membrane formation in three eyes (4.3%), and cystoid macular edema noted in one eye (1.4%). Conclusions Use of a scleral-fixated intraocular lens implantation without conjunctival peritomies and sclerotomy in ocular trauma patients during either primary pars plana vitrectomy or second silicone oil removal is a valuable approach for the management of traumatic aphakia in the absence of capsular support. Electronic supplementary material The online version of this article (10.1186/s12886-019-1172-4) contains supplementary material, which is available to authorized users.

A modified intrascleral intraocular lens fixation technique with fewer anterior segment manipulations: 27-gauge needle-guided procedure with built-in 8-0 absorbable sutures

“…[7] According to Holladay, spherical aberration resulting from abnormal IOL positioning was sufficient to decrease the visual acuity when the tilt was more than 7° and the decentration was more than 400 μm. [7,32] The mean tilt (2.27 ± 1.12°) and decentration (295 ± 125 μm) in our study are similar to those in other studies, suggesting that the impact on the optic system is acceptable. [1,2,6,7,33] The rate of mean endothelial cell loss was 7% ± 6%.…”

“…The exclusion criteria were preoperative intraocular pressure (IOP) of 25 mmHg or more while receiving antiglaucomatous agent treatment, scleritis, and a postoperative follow-up duration of less than 6 months. [7,12] were also obtained.…”

“…IOL decentration was defined as the horizontal distance between the midpoint of the reference line and IOL horizontal axis. [2,7] Both the horizontal 5 and vertical UBM images were used to analyze the mean IOL tilt and decentration.…”

“…[1][2][3][4][5] ACIOL or iris-fixed IOL implantation is convenient but might lead to corneal decompensation, iris chafing, uveitis-glaucoma-hyphema (UGH) syndrome or cystoid macular edema (CME). [6,7] Intrascleral-fixated IOL implantation therefore has some relative advantage with its more physiological location. It reduces the risk of corneal decompensation, peripheral anterior synechia, and secondary glaucoma by positioning the IOL further away from anterior segment structures.…”

“…It reduces the risk of corneal decompensation, peripheral anterior synechia, and secondary glaucoma by positioning the IOL further away from anterior segment structures. [7][8][9] Currently, intrascleral fixation of posterior chamber IOL implantation is widely performed because of its safety, efficacy, and stability.…”