Scleral-fixated and iris-fixated intraocular lens implantation or fixation:meta-analysis

Abstract

Scleral fixation and iris fixation are common intraocular lens (IOL) implantation techniques performed because of zonulopathy. There is a lack of consensus regarding their comparative efficacy and safety. This study aims to compare the efficacy and safety outcomes after scleral-fixated (SF) vs iris-fixated (IF) IOL implantation or fixation in adults. A systematic literature search was conducted on Ovid MEDLINE, Embase, and Cochrane CENTRAL from 2005 to 2020. 785 eyes from 2 randomized controlled trials and 9 nonrandomized studies were included. There was no significant difference in the mean corrected distance visual acuity at the final follow-up (P = .52) or absolute change in spherical equivalent (P = .88) between SF IOL and IF IOL implantation. The incidence of vitreous hemorrhage was significantly higher in the SF IOL group (risk ratio = 3.66, 95% CI, 1.16-11.55, P = .03). There were no differences in visual acuity and refractive outcomes between SF IOL and IF IOL implantation or fixation. Trade-offs in complications exist between the 2 techniques.

Relay Intrascleral 6-0 Polypropylene-Assisted Intraocular Lens Fixation: A Retrospective Comparison With Modified Yamane’s Technique.

“…A recent meta-analysis reported a trend toward better BCVA in patients undergoing sutured SF-IOL compared with those undergoing sutureless techniques. 11 In this study, both groups exhibited visual improvement at 12 months postoperatively, whereas the slight difference in the final letter gain seemingly resulted from the ceiling effect and additional factors, such as progressive IOL tilting and a larger proportion of patients with chronic CME in the control group. The notion that the relay-sutured group had worse BCVA at 3 months could be attributed to temporary vitreous hemorrhage occurring in two patients.…”

“…18,22 However, the proportions of haptic-related issues in our patients could not be directly compared with those identified in the original study because the X-70 model comes with polyvinylidene fluoride haptics that is more resilient to bending and breaking than PMMA. 4,5,11 This study's limitations are derived from its retrospective design and relatively short follow-up duration. In addition, it may be challenging to compare the measurements of the IOL position from this study with those from studies in the literature because the methods vary considerably.…”

“…18,22 However, the proportions of haptic-related issues in our patients could not be directly compared with those identified in the original study because the X-70 model comes with polyvinylidene fluoride haptics that is more resilient to bending and breaking than PMMA. 4,5,11…”

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

“…A sample-size weighted mean difference (MD) meta-analysis was performed for comparing final BCVAs, POM1 BCVA, post-operative ECC, and absolute SE error, as well as mean surgical durations between the Yamane and SSF treatment groups using the RevMan 5.4.1 software (Cochrane Collaboration, Copenhagen, Denmark) as previously described [ 7 , 43 ]. The RevMan 5.4.1 software was also used for meta-analysis of risk ratios (RRs) to compare complication rates, including CME and secondary surgery rates between Yamane and SSF techniques as previously described [ 11 , 43 , 44 ]. Due to the anticipated heterogeneity secondary to the variation in the protocols, follow-up durations, IOL types, and surgical technique, the random-effects model (DerSimonian and Laird method) was utilized.…”

“…IFIOLs are considered more technically challenging than ACIOLs but have been associated with the increased risk of an anatomic distortion of the pupil, uveitis from the pigment release, as well as vitreous hemorrhage [ 1 , 5 , 10 ]. Scleral-fixated IOLs are considered the most technically challenging technique and offer a significantly lower risk of damage to the anterior segment structures [ 11 ]; however, suture-related complications, such as suture erosion and breakage, can occur, which can potentially lead to the dislocation of the IOL [ 11 , 12 , 13 , 14 ].…”