J Korean Ophthalmol Soc.  2019 Jul;60(7):643-653. 10.3341/jkos.2019.60.7.643.

Scleral Fixation of Intraocular Lens and Retropupillary Fixation of Iris Claw Lens for Aphakic Eyes

• Kim JY
• Park CH
• Whang WJ
• Na KS
• Kim HS

• KMID: 2453015
• DOI: http://doi.org/10.3341/jkos.2019.60.7.643

Abstract

PURPOSE
To compare the efficacy and complications of scleral fixation of posterior chamber intraocular lens (IOL) and retropupillary fixation of iris claw IOL for dislocated IOL or aphakia without sufficient capsular support.
METHODS
This retrospective study was comprised of 17 eyes of 16 patients undergoing scleral fixation and 14 eyes of 13 patients undergoing retropupillary fixation from August 2013 to June 2018. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp examination, corneal topography, refractive indices, corneal curvatures, corneal endothelial cell density, and complications of both groups were examined preoperatively and 1 day, 1 week, 1 month, 2 months, and 6 months postoperatively.
RESULTS
Six months after the operation, UCVA and BCVA improved in both groups; however, there were no significant differences between the two groups (UCVA, p = 0.162; BCVA, p = 0.418). IOP was temporarily higher in the scleral fixation group at one day postoperatively (p = 0.023). The mean absolute prediction error was smaller in the retropupillary iris fixation group at 6 months postoperatively (p = 0.034). Postoperative total astigmatism, corneal astigmatism, and corneal endothelial cell density were not significantly different between the two groups.
CONCLUSIONS
The retropupillary iris fixation group did not show significant improvement in visual acuity compared with the scleral fixation group. However, the retropupillary iris fixation group provided better mean absolute prediction error and a low risk of postoperative increase in IOP compared with the scleral fixation group. Retropupillary fixation of iris claw IOL is a promising option for scleral fixation of posterior chamber IOL for dislocated IOL or aphakia without sufficient capsular support.

Keyword

Aphakic eye; Dislocated intraocular lens; Retropupillary fixation; Scleral fixation

MeSH Terms

Animals
Aphakia
Astigmatism
Corneal Topography
Endothelial Cells
Hoof and Claw*
Humans
Intraocular Pressure
Iris*
Lenses, Intraocular*
Refractometry
Retrospective Studies
Slit Lamp
Visual Acuity

Figure

• 

  Figure 1 Changes of uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and intraocular pressure (IOP) over time after scleral fixation of posterior chamber intraocular lens (IOL) or retropupillary fixation of iris claw IOL. (A) Six months after the operation, the UCVA in both groups significantly increased compared with that before the operation (the scleral fixation group, ‡p = 0.001; the retropupillary iris fixation group, ‡p = 0.001). In the sixth-month comparison, the UCVA in the retropupillary iris fixation group was not statistically better than the UCVA in the scleral fixation group (§p = 0.162). (B) Six months after the operation, the BCVA in both groups significantly increased compared with that before the operation (the scleral fixation group, ‡p = 0.001; the retropupillary iris fixation group, ‡p = 0.028). In the sixth-month comparison, the BCVA in the retropupillary iris fixation group was not statistically better than the BCVA in the scleral fixation group (§p = 0.418). (C) The IOP in the scleral fixation group was statistically higher than the IOP in the retropupillary iris fixation group in 1 day after the operation (†p = 0.023). Six months after the operation, the IOP in both groups did not significantly change compared with that before the operation, respectively (the scleral fixation group, ‡p = 0.481; the retropupillary iris fixation group, ‡p = 0.950). In the sixth-month comparison, the IOP in the scleral fixation group was not statistically higher than that in the retropupillary iris fixation group (§p = 0.058). logMAR = logarithm of minimal angle of resolution; Pre-op. = pre-operation; POD = post operative day; d = day; w = week; m = month(s). *Statistically significant differences (p < 0.05) among groups; †Mann Whitney U-test; ‡Wilcoxon signed rank test; §repeated-measures analysis of variance.

• 

  Figure 2 Changes of mean absolute prediction error over time after scleral fixation of posterior chamber intraocular lens (IOL) or retropupillary fixation of iris claw IOL. The mean absolute prediction error in the scleral fixation group was statistically higher than that in the retropupillary iris fixation group in 2 months, 6 months after the operation (*†p = 0.015, *†p = 0.034). Pre-op. = pre-operation; POD = post operative day; d = day; w = week; m = month(s). *Statistically significant differences (p < 0.05) among groups; †Mann Whitney U-test.

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