Korean J Ophthalmol.  2016 Apr;30(2):108-113. 10.3341/kjo.2016.30.2.108.

Short-term Clinical Outcomes after Transscleral Fixation Using the Intrascleral Pocket Technique: A Retrospective Cohort Study Analysis

• Cho YW
• Yoo WS
• Chung I
• Seo SW
• Yoo JM
• Kim SJ

• KMID: 2160460
• DOI: http://doi.org/10.3341/kjo.2016.30.2.108

Abstract

PURPOSE
To compare the two transscleral fixation (TSF) techniques of intrascleral pocket and conventional scleral flap with conjunctival division techniques in terms of short-term clinical effects.
METHODS
This retrospective cohort study included all consecutive patients with aphakia in Gyeongsang National University Hospital in Jinju, Korea, who underwent TSF between January 2012 and December 2014. The medical records of all patients were retrospectively reviewed, and the endothelial cell count (ECC), refraction, best-corrected visual acuity (BCVA), intraocular pressure, slit lamp, and fundus examination results before and 1 day and 6 months after surgery were recorded. The postoperative complications and visual outcomes were also recorded.
RESULTS
The intrascleral pocket and conventional-flap groups did not differ significantly in terms of demographics, presurgical BCVA, or ECC. However, the intrascleral pocket group had a significantly lower BCVA at 1 day and 6 months after surgery compared to the conventional-flap group. The two groups did not differ in terms of ECC 6 months after surgery. The intrascleral pocket group had no postoperative complications, but five patients in the conventional-flap group complained of irritation. In both groups, the intraocular lens was well positioned without tilting or subluxation, and astigmatism was significantly reduced at 1 day and 6 months after surgery.
CONCLUSIONS
The intrascleral pocket technique of TSF does not involve conjunctival dissection and is a successful method of sulcus fixation. It stably corrects the intraocular lens and is easy to perform, which helps to reduce operation time. It also reliably yields rapid visual acuity recovery without complications.

Keyword

Aphakia; Intrascleral pocket technique; Transscleral fixation

MeSH Terms

Aphakia
Astigmatism
Cohort Studies*
Demography
Endothelial Cells
Gyeongsangnam-do
Humans
Intraocular Pressure
Korea
Lenses, Intraocular
Medical Records
Postoperative Complications
Retrospective Studies*
Visual Acuity

Figure

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  Fig. 1 Intrascleral pocket technique. (A,B) Two points were marked at 180° apart at the limbus. To create a 2-mm-sized pocket, lamellar dissection without conjunctival dissection was performed with a crescent blade. (C) The constructed pocket was visualized. (D) A 9-0 straight needle was passed through the transconjunctival transcleral passage. (E) A three-piece foldable acrylic intraocular lens was inserted via clear corneal incision, and then each haptic end was exteriorized through clear corneal incision and tied with prolene suture. (F) The suture was placed in the intrascleral pocket with forceps opening one part of the pocket. (G,H) Each knot was buried under scleral flaps to prevent exposure, and the conjunctiva was joined without suture.

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  Fig. 2 The intrascleral pocket group and conventional-flap group demonstrated significant decrease in spherical diopter (A) and astigmatism (B) at 1 day and 6 months after the operation. *Paired t-test.

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  Fig. 3 (A) Anterior segment photography and (B) anterior optical coherence tomography 6 months after the surgery showed a clean wound without dehiscence or knot exposure.

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