J Korean Ophthalmol Soc.  2016 Jan;57(1):43-49. 10.3341/jkos.2016.57.1.43.

Long-Term Results of Transscleral Fixation of Posterior Chamber Intraocular Lens

• Oh JR
• Ohn YH

• KMID: 2213836
• DOI: http://doi.org/10.3341/jkos.2016.57.1.43

Abstract

PURPOSE
To investigate the long-term results of transscleral fixation of posterior chamber intraocular lens (IOL) for unstable posterior capsular supporting structure.
METHODS
We performed a retrospective review of 67 patients (67 eyes) with unstable posterior capsular supporting structure who underwent transscleral fixation at Soonchunhyang University Bucheon Hospital from March 2005 to January 2013. Transscleral fixation without scleral flap was performed by a single surgeon. We analyzed the causes of transscleral fixation and compared postoperative best-corrected visual acuity (BCVA) and spherical diopter.
RESULTS
Among the 67 eyes of 67 patients, the causes of transscleral fixation included IOL subluxation (33 cases, 49.2%), IOL dislocation (11 cases, 16.4%), intraoperative posterior capsule rupture (8 cases, 11.9%), aphakia associated with previous intraocular surgery (7 cases, 10.4%), crystalline lens disorder with zonular dialysis (4 cases, 5.9%) and IOL opacity (4 cases, 5.9%). The mean BCVA before surgery was 1.26 +/- 0.94 (log MAR) and the visual acuity improved to 0.59 +/- 0.71, 0.60 +/- 0.69, 0.58 +/- 0.70, 0.55 +/- 0.70, 0.60 +/- 0.58 and 0.66 +/- 0.70 (1 week, 1 month, 3 months, 1 year, 3 years and 5 years, respectively, after the surgery; p < 0.05).
CONCLUSIONS
Posterior chamber IOL transscleral fixation in unstable posterior capsular supporting structure is effective for increasing visual acuity and spherical diopter. Specifically, the most improvement was observed at one month after surgery. Transscleral fixation is an adequate surgical procedure for fast improvement of visual acuity with long-term effects.

Keyword

Transscleral fixation

MeSH Terms

Aphakia
Dialysis
Dislocations
Gyeonggi-do
Humans
Lens, Crystalline
Lenses, Intraocular*
Retrospective Studies
Rupture
Visual Acuity

Figure

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  Figure 1. Knot location of posterior chamber intraocular lens transscleral fixation. (A, B) A polypropylene is fixed in the outer one-third point of haptic.

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  Figure 2. Technique for the ab externo approach of posterior chamber intraocular lens (IOL) transscleral fixation. (A) The long curved double-armed 10-0 polypropylene needle is passed through the sclera approximately 1.0 mm posterior to the limbus. A sec-ond hollow needle is passed from the opposite side of the eye. (B) A hook is used to pull the suture out through a superior scleral tunnel wound so that it can be tied to the intraocular lens. (C) Suture is cut, and each end is tied to a haptic of the intraocular lens. After the IOL is placed into position. (D) The scleral sutures must be anchored to the sclera.

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  Figure 3. BCVA and refractive indexes change after surgery. The mean BCVA before surgery was 1.26 ± 0.94 (log MAR) and the visual acuity improved to 0.66 ± 0.70 at 5 years after the surgery. The spherical diopter before surgery was 5.80 ±5.86 diopters and it improved to 0.56 ± 1.12 diopters at 5 years after the surgery. The cylindrical diopter change shows no significant value. BCVA = best corrected visual acuity.

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  Figure 4. IOP change after surgery. After surgery, there were 33 cases of transient ocular hypertension and 5 cases of tran-sient ocular hypotension. At first day after surgery, the aver-age of ocular hypertension was 33.0 ± 12.42 mm Hg and average of ocular hypotension was 7.8 ± 0.83 mm Hg. The abnormal range of intraocular pressure was controlled within 1 month by conservative treatment. IOP = intraocular pressure.

Reference

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