Comparison of Clinical Outcomes among Conventional Scleral Fixation, Retropupillary Iris-claw Intraocular Lens Implantation, and Intrascleral Fixation

Abstract

Purpose: To compare the efficacy and safety of conventional scleral fixation (C-SF), retropupillary iris-claw intraocular lens (RP-IOL) implantation, and intrascleral fixation (ISF).

Methods: This retrospective observational study included 58 patients (58 eyes) who underwent C-SF (23 eyes), RP-IOL (23 eyes), and ISF (12 eyes) by a single surgeon at Samsung Medical Center from October 2017 to July 2020 and were followed up for at least 6 months. This study analyzed various clinical outcomes before surgery, and 1 day, 1 week, 1 month, 3 months, and 6 months after surgery.

Results: Six months after surgery, best-corrected visual acuity in logarithm of minimum angle of resolution was 0.08 ± 0.10, 0.08 ± 0.16, and 0.03 ± 0.04 in C-SF group, RP-IOL group, and ISF group, respectively, and there was a significant improvement in each group compared to preoperative best-corrected visual acuity. All groups showed a significant increase in astigmatism postoperatively, but no between-group differences were observed. The prediction error was -0.15 ± 0.77, 0.56 ± 0.62, and 0.44 ± 1.00 diopters in the three groups, respectively, indicating RP-IOL group and ISF group for hyperopic shift. The three groups did not differ in terms of absolute prediction error. Six months after surgery, the corneal endothelial cell counts were 2,073 ± 691, 2,014 ± 692, and 1,712 ± 891 cells/mm2, respectively, which were lower than before surgery. IOL dislocation occurred in five eyes only in RP-IOL group, two of which underwent two reoperations, and reenclavation was performed smoothly without complications in all cases.

Conclusions: Although the frequency of IOL dislocation in RP-IOL group was higher than that in the other groups, it can be reenclavated relatively easily. As a method of secondary IOL fixation, both RP-IOL implantation and ISF were as effective as conventional scleral fixation.

Keywords: Aphakia; Artisan; Intraocular lenses; Intrascleral fixation; Scleral fixation.

Fig. 1

Changes in postoperative uncorrected visual acuity (UCVA) over time after conventional scleral fixation (C-SF), retropupillary iris-claw intraocular lens (RP-IOL) implantation, and intrascleral fixation (ISF). After 6 months of surgery, UCVA was significantly improved in all three groups. There were no differences between the three groups throughout the entire follow-up period (p > 0.05, Kruskal-Wallis test). logMAR = logarithm of the minimal angle of resolution.

Fig. 2

Changes in postoperative best-corrected visual acuity (BCVA) over time after conventional scleral fixation (C-SF), retropupillary iris-claw intraocular lens (RP-IOL) implantation, and intrascleral fixation (ISF). After 6 months of surgery, BCVA was significantly improved in all three groups. There were no differences between the three groups throughout the entire follow-up period (p > 0.05, Kruskal-Wallis test). logMAR = logarithm of the minimal angle of resolution.

Fig. 3

Changes in postoperative intraocular pressure (IOP) over time after conventional scleral fixation (C-SF), retropupillary iris-claw intraocular lens (RP-IOL) implantation, and intrascleral fixation (ISF). During the postoperative follow-up period, IOP was maintained stable in all three groups.

Fig. 4

Changes in postoperative endothelial cell count ( ECC) over time after conventional scleral fixation (C-SF), retropupillary iris-claw intraocular lens (RP-IOL) implantation, and intrascleral fixation (ISF). In all groups, ECC decreased significantly after surgery, but no difference was observed between groups, and remained above 1,700 cells/mm².