Long-term outcome of combined vitrectomy and transscleral suture fixation of posterior chamber intraocular lenses in the management of posteriorly dislocated lenses

Abstract

Background: There is no general consensus on the optimal choice of intraocular lenses (IOLs) or fixation methods in eyes with inadequate capsular support. The purpose of this study was to determine the long-term safety, efficacy and refractive status of combined vitrectomy and transscleral suture fixation of posterior chamber (PC) IOLs in the management of posteriorly dislocated lenses in Taiwan.

Methods: We conducted a retrospective interventional study at our medical facility. The posteriorly dislocated crystalline lenses (or dislocated IOL) were removed with pars plana vitrectomy followed by transscleral suture fixation of PC IOLs at the same setting. Additionally, preexisting ocular condition, postoperative visual acuity (VA) and refraction were recorded.

Results: Fifteen patients were enrolled for analysis, including traumatic posteriorly dislocated IOLs in seven cases, and traumatic posteriorly dislocated crystalline lenses or retained lens nuclei after cataract surgery in eight cases. The end result of our study showed that best-corrected VA of 6/12 or better was achieved in 13 patients (87%) after a mean 45 months follow-up. The mean VA significantly improved from 0.98 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.14 logMAR at last follow-up (p < 0.01). The refractive status after suture fixation of PC IOL revealed a mean myopic shift of -1.18 ± 1.47 D from the predicted spherical equivalent. Overall, most complications were minor. Ciliary body hemorrhage occurred during operation in one case and was cleared without visual compromise. Erosion of prolene suture through conjunctiva was noted in three patients. Elevated intraocular pressure was well controlled by topical antiglaucoma medications in three cases. No suture breakage or IOL dislocation was noted in any of the patients. There were no serious adverse events of retinal detachment, corneal compromise, or endophthalmitis in any of the patients.

Conclusion: Our data showed that use of combined vitrectomy and transscleral suture fixation of PC IOLs is a safe and efficient technique to correct aphakia in eyes without adequate capsular support. Our study demonstrated good long-term visual outcome with only minor complications. Furthermore, we recommend that the IOL power should be adjusted 1.00 D less for transscleral suture fixation.

Keywords: intraocular lenses; lens dislocation; pars plana vitrectomy; scleral fixation.