J Korean Ophthalmol Soc.  2015 Apr;56(4):548-558. 10.3341/jkos.2015.56.4.548.

Refractive Change after Transscleral Fixation of Intraocular Lens

• Ahn YS
• Park YL
• Kim HS

• KMID: 2215705
• DOI: http://doi.org/10.3341/jkos.2015.56.4.548

Abstract

PURPOSE
To evaluate the anterior chamber depth (ACD), extent of intraocular lens (IOL) tilt, and decentration and refractive error after transscleral fixation of IOL.
METHODS
We retrospectively reviewed the medical records of 17 cases with transscleral fixation of IOL (6 with aphakia, 5 with IOL dislocation, and 6 with lens subluxation). The acrylic IOL (MN60AC(R)) was fixated in 12 eyes and the polymethylmethacrylate IOL (CZ70BD(R)) was fixated in 5 eyes at 1.0 mm posterior from the limbus. We analyzed the ACD, extent of IOL tilt and decentration, manifest refraction, refractive error, higher order aberration, and corneal endothelium at 2 weeks, 1 month and 2 months postoperatively.
RESULTS
The mean ACD was 3.36 +/- 0.11 mm, 3.30 +/- 0.12 mm, and 3.27 +/- 0.13 mm, the mean extent of IOL tilt was 4.61 +/- 0.12degrees, 4.65 +/- 0.14degrees, and 4.60 +/- 0.12degrees and the mean extent of IOL decentration was 0.43 +/- 0.01 mm, 0.45 +/- 0.01 mm, and 0.45 +/- 0.01 mm at 2 weeks, 1 month and 2 months postoperatively, respectively in eyes with transscleral fixation of IOL. The ACD was shallower and the extent of IOL tilt and decentration was greater than with IOL in-the-bag insertion patients. The mean refractive errors were -0.55 +/- 0.27 D, -0.63 +/- 0.24 D, and -0.69 +/- 0.19 D at the same period, respectively.
CONCLUSIONS
Although postoperative refractive error is influenced by surgeon factors such as incision size, distance of fixation suture from limbus, and tightness of suture material, according to our results, an IOL 0.75 D more hyperopic than predicted should be selected in transscleral fixation of IOL at 1.0 mm posterior from the limbus. Additionally, each surgeon should assess their specific results and modify the lens calculations accordingly.

Keyword

Decentration; Intraocular lens; Refractive error; Tilt; Transscleral fixation

MeSH Terms

Anterior Chamber
Aphakia
Dislocations
Endothelium, Corneal
Humans
Lenses, Intraocular*
Medical Records
Polymethyl Methacrylate
Refractive Errors
Retrospective Studies
Sutures
Polymethyl Methacrylate

Figure

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  Figure 1. Scatterplot of correlation between the anterior chamber depth, IOL decentration, and IOL tilting with spherical equivalent (SE) error at postoperative 2 months in eyes with transscleral fixation of IOL. ACD = anterior chamber depth; IOL = intraocular lens.

Reference

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