Outcomes of using sutureless, scleral-fixated posterior chamber intraocular lenses
What:
Paper Presentation | Présentation d'article
When:
4:25 PM, Saturday 2 Jun 2018
(10 minutes)
Where:
How:
Authors: Oluwadara Onasanya, Vinay Kansal, Kevin Colleaux, Nigel Rawlings
Author Disclosure Block: O. Onasanya: None. V. Kansal: None. K. Colleaux: Grant/research support; Alcon, Novartis. Employment/honoraria/consulting fees; Allergan bayer, novartis, Bausch and Lomb, Bayer, Novartis. Membership on an advisory panel, standing committee or board of directors; Allergan, Bayer, Novartis. N. Rawlings: None.
Abstract Body:
Purpose: To describe the indications, visual outcomes and complications of sutureless, scleral-fixated posterior chamber intraocular lens (SFIOL) implantation.
Study Design: Retrospective chart review
Methods: This retrospective chart review identified 135 eyes who underwent SFIOL implantation at Saskatoon City Hospital (Saskatoon, Saskatchewan, Canada) from July 2013 to August 2017 by two vitreo-retinal surgeons. Patients were ≥18 years of age. Data was collected on patient demographics, clinical history, ocular history, pre-operative ocular characteristics (visual acuity, manifest refraction, corneal power, lens status, intra-ocular pressure (IOP)), operative details, post-operative visual outcomes, and complications. Visual and refractive outcomes were compared between the pre-operative and latest post-operative visit using repeated measures analysis of variance (ANOVA).
Results: 78 patients were female (57.8%), with the mean patient age of 72.9 ± 15.5 years. The mean follow-up was 10.9 ± 10.5 months. Dislocated IOL due to zonular weakness was the primary indication for SFIOL implantation (88 eyes (65.2%)). Alcon MA60AC lens was implanted in 111 (68.2%) eyes, with the remaining eyes having a pre-existing IOL fixated. Compared to baseline pre-operative assessment, at latest follow-up there was improvement in uncorrected visual acuity (1.4 ± 0.9 to 0.67 ± 0.60 logMAR, p<0.01), best corrected visual acuity (BCVA) (0.7 ± 0.5 logMAR to 0.37 ± 0.38 logMAR, p<0.01). Changes in absolute spherical and cylindrical refraction were not significant. The most frequent post operative complications were IOP elevation >30mmHg (23.7%), vitreous hemorrhage (VH) (17.8%), cystoid macular edema (CME) (11.9%), hypotony (11.1%), iris capture (10.4%), uveitis-glaucoma-hyphema (UGH) syndrome (10.4%). Operative reinterventions included SFIOL exchange (subluxed SFIOL-0.7%, broken haptic-2.2%), SFIOL repositioning (iris capture-5.2%), SFIOL removal (UGH syndrome-1.5%, broken haptic-0.7%), pars plana vitrectomy (VH-2.2%, cataract remnant-0.7%, hypotony-1.5%)), trabeculectomy (high IOP-1.5%). 11 (8.1%) patients required multiple re-interventions.
Conclusions: SFIOL implantation is a reasonable option for eyes with inadequate capsular support. This technique resulted in a visual improvement in most patients. Many of the surgical complications were related to a floppy iris-lens diaphragm (VH, UGH syndrome, iris capture). Some of the eyes with complex pathology such as high myopia or previous trauma were predisposed to this. Surgical modifications can be made to minimize the iris-related complications.
Author Disclosure Block: O. Onasanya: None. V. Kansal: None. K. Colleaux: Grant/research support; Alcon, Novartis. Employment/honoraria/consulting fees; Allergan bayer, novartis, Bausch and Lomb, Bayer, Novartis. Membership on an advisory panel, standing committee or board of directors; Allergan, Bayer, Novartis. N. Rawlings: None.
Abstract Body:
Purpose: To describe the indications, visual outcomes and complications of sutureless, scleral-fixated posterior chamber intraocular lens (SFIOL) implantation.
Study Design: Retrospective chart review
Methods: This retrospective chart review identified 135 eyes who underwent SFIOL implantation at Saskatoon City Hospital (Saskatoon, Saskatchewan, Canada) from July 2013 to August 2017 by two vitreo-retinal surgeons. Patients were ≥18 years of age. Data was collected on patient demographics, clinical history, ocular history, pre-operative ocular characteristics (visual acuity, manifest refraction, corneal power, lens status, intra-ocular pressure (IOP)), operative details, post-operative visual outcomes, and complications. Visual and refractive outcomes were compared between the pre-operative and latest post-operative visit using repeated measures analysis of variance (ANOVA).
Results: 78 patients were female (57.8%), with the mean patient age of 72.9 ± 15.5 years. The mean follow-up was 10.9 ± 10.5 months. Dislocated IOL due to zonular weakness was the primary indication for SFIOL implantation (88 eyes (65.2%)). Alcon MA60AC lens was implanted in 111 (68.2%) eyes, with the remaining eyes having a pre-existing IOL fixated. Compared to baseline pre-operative assessment, at latest follow-up there was improvement in uncorrected visual acuity (1.4 ± 0.9 to 0.67 ± 0.60 logMAR, p<0.01), best corrected visual acuity (BCVA) (0.7 ± 0.5 logMAR to 0.37 ± 0.38 logMAR, p<0.01). Changes in absolute spherical and cylindrical refraction were not significant. The most frequent post operative complications were IOP elevation >30mmHg (23.7%), vitreous hemorrhage (VH) (17.8%), cystoid macular edema (CME) (11.9%), hypotony (11.1%), iris capture (10.4%), uveitis-glaucoma-hyphema (UGH) syndrome (10.4%). Operative reinterventions included SFIOL exchange (subluxed SFIOL-0.7%, broken haptic-2.2%), SFIOL repositioning (iris capture-5.2%), SFIOL removal (UGH syndrome-1.5%, broken haptic-0.7%), pars plana vitrectomy (VH-2.2%, cataract remnant-0.7%, hypotony-1.5%)), trabeculectomy (high IOP-1.5%). 11 (8.1%) patients required multiple re-interventions.
Conclusions: SFIOL implantation is a reasonable option for eyes with inadequate capsular support. This technique resulted in a visual improvement in most patients. Many of the surgical complications were related to a floppy iris-lens diaphragm (VH, UGH syndrome, iris capture). Some of the eyes with complex pathology such as high myopia or previous trauma were predisposed to this. Surgical modifications can be made to minimize the iris-related complications.
