J Korean Ophthalmol Soc.  2018 Jul;59(7):657-664. 10.3341/jkos.2018.59.7.657.

Clinical Outcomes of Combined Vitrectomy and Intrascleral Fixation of New Intraocular Lenses in In-the-bag Dislocations

• Lee MS
• Chae SH
• Bang CW
• Jeon HM
• Yoon HS

• KMID: 2416268
• DOI: http://doi.org/10.3341/jkos.2018.59.7.657

Abstract

PURPOSE
To investigate the clinical outcomes of combined vitrectomy and intrascleral fixation of a new posterior chamber intraocular lens (PC IOL) as a treatment for IOL dislocation.
METHODS
We conducted a retrospective interventional study at our medical facility from January 2015 to January 2017. Posteriorly dislocated IOLs were removed with pars plana vitrectomy. Two intrascleral tunnels, 2.0 mm in length, were created 1.5 mm to the limbus at 6 and 12 o'clock positions. Both haptics of new foldable acrylic 3-piece IOLs were inserted into the tunnel until the IOL was secured in a central position. We analyzed the preexisting ocular condition, visual acuity (VA), and refractive error preoperatively and postoperatively, and recorded postoperative complications.
RESULTS
Forty-nine patients (50 eyes) were enrolled in the study. The mean follow-up period was 12.8 ± 6.6 months. A best-corrected VA of 6/12 or better was achieved in 43 eyes (86%). The mean VA significantly improved from 0.32 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.18 logMAR at last follow-up (p = 0.03). The refractive status after intrascleral fixation of the PC IOL revealed a mean hyperopic shift of +1.09 ± 1.28 diopters from the predicted spherical equivalent. Postoperative vitreous hemorrhages occurred in six cases and were cleared without visual compromise. Cystoid macular edema was well-controlled by topical nonsteroidal anti-inflammatory drugs (NSAID) medications in two cases. In two cases, IOL dislocation recurred and required re-operation. There were no serious adverse events of suture-related complications, retinal detachment, corneal compromise, or endophthalmitis in any of the patients.
CONCLUSIONS
Our data revealed that use of combined vitrectomy and intrascleral fixation of PC IOLs is a safe and efficient technique to correct IOL dislocation. We observed good visual outcomes with only minor complications.

Keyword

Intraocular lens dislocation; Intrascleral fixation; Pars plana vitrectomy; Posterior chamber intraocular lens

MeSH Terms

Dislocations*
Endophthalmitis
Follow-Up Studies
Humans
Lenses, Intraocular*
Macular Edema
Postoperative Complications
Refractive Errors
Retinal Detachment
Retrospective Studies
Visual Acuity
Vitrectomy*
Vitreous Hemorrhage

Figure

• 

  Figure 1. Technique for the intrascleral fixation of intraocular lens (IOL). (A) Scleral tunnel created 1.5 mm from the limbus using a paracentesis incision diamond knife. Detailed view (inset) of the diamond knife. (B) Transscleral incision created perpendicular to the scleral tunnel. 3-dimensional view (inset) of the scleral tunnel and transscleral incision. (C) The leading haptic of the secondary IOL is grasped with 23-gauge intraocular forceps. (D) The leading haptic is pulled through the transscleral incision, and left externalized. (E) The McPherson forceps grasps the externalized tip, inserts the IOL haptic into the tunnel. (F) The tailing haptic is then inserted into the second scleral tunnel, and the two tunnels were closed in a conventional manner.

• 

  Figure 2. Mean best corrected visual acuity (BCVA) changes after surgery. The mean BCVA before surgery was 0.34 ± 0.47 (logMAR) and the BCVA improved to 0.18 ± 0.32 at final follow-up. Note the temporary deterioration of BCVA at the first month after surgery. PreOP = preoperative; POD = postoperative day; m = month(s). *Paired t-test.

Reference

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