Transscleral fixation of acrylic intraocular lenses in the absence of capsular support through 3.5 mm self-sealing incisions

Abstract

Purpose: To evaluate the safety and efficacy of transscleral ciliary sulcus fixation of acrylic intraocular lenses (IOLs) through small incisions in the management of secondary IOL implantation.

Setting: Department of Ophthalmology, Osaka Rosai Hospital, Osaka, Japan.

Methods: This retrospective study consisted of 28 patients (30 eyes) who had transscleral fixation of acrylic IOLs through 3.5 mm incisions. All patients were followed for a minimum of 6 months in several different clinical settings. Data on visual acuity, keratometry, and central corneal endothelial cell count were evaluated preoperatively and postoperatively. The refractive error achieved and incidence of postoperative complications were determined.

Results: Uncorrected visual acuity (UCVA) improved in all eyes. Of the 18 eyes without pre-existing pathology, 11 (61.1%) had a UCVA of 20/40 or better from 1 week postoperatively. Best corrected visual acuity was unchanged in 24 eyes (80.0%) and improved by 2 Snellen lines or more in 5 eyes (16.7%) at the final examination. Self-sealing wound adaptation was achieved in 25 eyes (83.3%). The mean scalar shift in keratometric cylinder was 1.25 diopters (D) at 1 day postoperatively, 1.17 D at 1 week, and 1.06 D at 3 months. The rate of central corneal endothelial loss 6 months postoperatively averaged 7.84%. No intraoperative complications that were directly associated with acrylic IOL implantation occurred. Postoperative complications that included transient ocular hypertension, slight vitreous hemorrhage, and IOL malposition were found in a small population but resolved spontaneously without further surgical intervention.

Conclusions: The good visual outcomes and low incidence of complications achieved in the present study indicate that acrylic IOLs positioned through small incisions might be considered for ciliary sulcus fixation. However, evaluation of this technique in a large population over the long term is required.