Outcomes of four-point suture fixated and two-point sutureless posterior chamber IOLs combined with pars plana vitrectomy

Abstract

Background While each scleral fixation method has its own advantages, there is a lack of strong evidence to suggest a superior technique. Advances in cataract surgery expand patient eligibility for successful cataract extraction, benefitting a growing population of pseudophakic patients. However, implantation of secondary intraocular lens (IOL) with compromised anterior or posterior capsule is a more challenging task. Each method of scleral fixation has its own advantages and none of them has strong evidence to be superior. This paper describes postsurgical outcomes of two scleral intraocular(IOL) fixation techniques combined with pars plana vitrectomy(PPV) from a single tertiary referral eye center. Methods Patients underwent PPV and IOL implantation with either four-point sutured scleral fixation (Akreos AO60(AK); n = 24) or two-point sutureless flanged intrascleral fixation (CT Lucia(CTL); n = 7). Reports include IOL and sclerotomy placement, fixation techniques, and IOL model. Results Thirty-one eyes of thirty patients were analyzed. Average change in vision from baseline measurement was LogMAR − 0.68 ± 0.66 and − 0.90 ± 0.63 for AK and CTL groups, respectively. Average postoperative refractive error was − 0.3 ± 1.03 D (AK) and 0.4 ± 0.60 D (CTL). No opacification cases of Akreos lens were found in this study with the longest follow up of 53 months. Conclusions Both methods of implantation (sutured and sutureless) could provide good visual and refractive outcomes. Minimal complication rates were reported despite including patients with multiple comorbidities, making both techniques an attractive choice for secondary IOL implantation.

Clinical Outcomes in Scleral Fixation Secondary Intraocular Lens with Yamane versus Suture Techniques: A Systematic Review and Meta-Analysis

“…The thirteen studies used for the present meta-analysis were published from 2021 to 2023 and included 737 eyes (331 Yamane, 406 SSF). Ten of the thirteen studies were retrospective cohort analyses [ 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 31 ], while three were prospective [ 5 , 21 , 29 ]. One of the prospective studies was randomized.…”

“…A summary of the cumulative complications across studies is depicted in Table 2. [5,20,[22][23][24][25][26]30,31]. The combined effect and 95% CI are also shown (according to random-effect estimations).…”

“…There was no subgroup analysis carried out for this group as there were only three studies reporting the absolute refractive error. [20,[22][23][24][25][26][27][28][29]31]. The summary mean difference and 95% CI are also shown (according to random-effect estimations).…”

“…Since the publication of the Yamane technique, numerous studies have been published comparing the two procedures in terms of outcomes and complications [ 5 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. Studies have demonstrated that surgeons with greater experience in specific ophthalmic techniques have more favorable results with improved visual recovery after surgery, and, thus, it is important to consider surgeon experience when comparing these two methods [ 32 , 33 ].…”

Compare the outcome of different scleral fixation (SFIOL) and retropupillary iris-claw intraocular lens (RPICIOL) in correcting aphakia: a meta-analysis

“…They involved ve studies comparing the Yamane and Iris claw techniques 10,14,16,18,19 , 9 studies comparing the Prolene 10.0 suture and Iris claw techniques 1,11,16,20,21,22,23,24,25 . In addition, three studies comparing Iris claw and Sutureless scleral tuck Scharioth pocket 26,27,28 , and 2 studies comparing the Yamane and Gore-Tex suture techniques 29,30 . Three studies were excluded as they involved the comparison of 4 anged technique prolene 5.0 with three different techniques 31,32,33 .…”