Journal List > J Korean Ophthalmol Soc > v.58(10) > 1010646

Lee, Kim, Park, Na, and Kim: Comparison of Short-term Clinical Outcomes between Scleral Fixation vs. Iris Fixation of Dislocated IOL

Abstract

Purpose

To compare clinical outcomes between iris fixation and scleral fixation as treatments for dislocated Intra Ocular Lens.

Methods

Ten eyes of 10 patients underwent scleral fixation (scleral fixation group) and 8 eyes of 8 patients underwent iris fixation (iris fixation group) were enrolled in this retrospective study. In each group, visual acuity and intra ocular pressure, slit lamp examination, fundus examination, refraction, keratometry, axial length and anterior chamber depth were measured before the surgery. Regular follow up was made 1 day, 1 week, 1 month, and 2 months after surgery and visual acuity, intra ocular pressure, slit lamp exam, refractory error, anterior chamber depth, intraocular lens (IOL) tilting, and decentration were measured at each visit.

Results

There were no significant differences in uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and refractive error for patients with iris and scleral fixation before and after surgery. Patients with iris fixation had significantly deeper anterior chamber depth (ACD) and more IOL tilting than patients with scleral fixation.

Conclusions

In this study, the iris fixation group tended to have more IOL tilting and deepening of anterior chamber depth than the scleral fixation group. We can use this information to choose the appropriate surgical method for dislocated IOL and to select of new IOL.

References

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Figure 1.
Representative images of dislocated intraocular lens. (A) Inferonasally tilted lens (B) Inferiorly tilted lens.
jkos-58-1131f1.tif
Figure 2.
Changes of Anterior chamber depth (ACD) over time after Scleral or Iris fixation of intraocular lens (mm). Patients with iris fixation had significantly deeper ACD than patients with scleral fixation. Pre-op. = pre-operative; POD = post operative day; w = week; m = month(s). * Values which are statistically significant.
jkos-58-1131f2.tif
Figure 3.
Changes of intraocular lens (IOL) tilting (°) over time after Scleral or Iris fixation of IOL. Patients with iris fixation had more IOL tilting than patients with scleral fixation. POD = post operative day; w = week; m = month(s). * Values which are statistically significant.
jkos-58-1131f3.tif
Table 1.
Preoperative clinical characteristics of Scleral fixation group & Iris fixation group
  Method of surgery
p-value
Scleral fixation (n = 10) Iris fixation (n = 8)
Sex M = 8, F = 2 M = 6, F = 2  
Age (years) 53.71 ± 3.80 64.67 ± 2.85 0.124
UCVA (logMAR) 1.01 ± 0.09 0.98 ± 0.31 0.374
BCVA (logMAR) 0.44 ± 0.06 0.30 ± 0.11 0.110
IOP (mmHg) 16.71 ± 1.00 19.38 ± 3.13 0.887
ACD (mm) 3.15 ± 0.25 3.72 ± 0.31 0.215
Axial length (mm) 24.65 ± 0.47 24.29 ± 0.83 0.247
Corneal endothelium (cells/mm2) 2,385.06 ± 163.70 1,960.25 ± 232.59 0.175
Refraction (D, spherical equivalent) 1.23 ± 2.51 2.21 ± 2.71 0.731

Values are presented as mean ± SD unless otherwise indicated. Mann Whitney U-test was used.

M = male; F = female; UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity; IOP = intraocular pressure; ACD = anterior chamber depth.

Table 2.
Changes of UCVA, BCVA, ACD and IOP over time in Scleral fixation group & Iris fixation group
  Method of surgery
p-value
Scleral fixation (n = 10) Iris fixation (n = 8)
UCVA (logmar)      
 Pre-op. 1.01 ± 0.09 0.98 ± 0.31 0.374
 POD#1w 0.48 ± 0.05 0.81 ± 0.32 0.374
 POD#1m 0.41 ± 0.04 0.69 ± 0.21 0.215
 POD#2m 0.36 ± 0.03 0.63 ± 0.24 0.187
BCVA (logmar)      
 Pre-op. 0.44 ± 0.06 0.30 ± 0.11 0.110
 POD#1w 0.25 ± 0.04 0.37 ± 0.20 0.546
 POD#1m 0.22 ± 0.03 0.25 ± 0.12 0.829
 POD#2m 0.19 ± 0.04 0.27 ± 0.09 0.416
ACD (mm)      
 Pre-op. 3.15 ± 0.25 3.72 ± 0.31 0.215
 POD#1w 3.36 ± 0.11 3.95 ± 0.25 0.071
 POD#1m 3.30 ± 0.12 4.30 ± 0.18 0.001*
 POD#2m 3.27 ± 0.13 4.22 ± 0.20 0.002*
ACD diff. (mm) 0.24 ± 0.15 0.48 ± 0.23 0.032*
IOP (mmHg)      
 Pre-op. 16.71 ± 1.00 19.38 ± 3.13 0.887
 POD#1w 16.12 ± 0.81 21.63 ± 2.95 0.140
 POD#1m 18.06 ± 0.88 19.38 ± 1.92 0.511
 POD#2m 17.71 ± 1.06 18.14 ± 2.60 0.664

Values are presented as mean ± SD unless otherwise indicated. Mann Whitney U-test was used.

UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity; ACD = anterior chamber depth; IOP = intraocular pressure; Pre-op. = pre-operative; POD = post operative day; w = week; m = month(s); ACD diff. = difference between ACD of 2 month after the surgery and of preoperative.

* Statistically significant differences (p-value < 0.05) among groups.

Table 3.
Changes of IOL tilting, IOL decentration, Spherical equivalent error over time in Scleral fixation group & Iris fixation group
  Method of surgery
p-value
Scleral fixation (n = 10) Iris fixation (n = 8)
IOL tilting (°)      
 POD#1w 4.61 ± 0.12 7.48 ± 0.97 <0.001*
 POD#1m 4.65 ± 0.14 5.08 ± 0.27 0.101
 POD#2m 4.60 ± 0.12 5.16 ± 0.19 0.024*
IOL decentration (mm)      
 POD#1w 0.43 ± 0.01 0.49 ± 0.06 0.144
 POD#1m 0.45 ± 0.01 0.44 ± 0.04 1.000
 POD#2m 0.45 ± 0.01 0.49 ± 0.04 0.574
Spherical equivalent error (D)      
 POD#1w –0.55 ± 0.27 –0.50 ± 0.26 0.698
 POD#1m –0.63 ± 0.24 –0.65 ± 0.41 0.820
 POD#2m –0.69 ± 0.19 –0.76 ± 0.59 0.820

Values are presented as mean ± SD unless otherwise indicated. Mann Whitney U-test was used.

IOL = intraocular lens; POD = post operative day; w = week; m = month(s).

* Statistically significant differences (p-value < 0.05) among groups.

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