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

Joo Young Kim; Chang Hyun Park; Woong Joo Whang; Kyung Sun Na; Hyun Seung Kim

doi:10.3341/jkos.2019.60.7.643

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Kim, Park, Whang, Na, and Kim: Scleral Fixation of Intraocular Lens and Retropupillary Fixation of Iris Claw Lens for Aphakic Eyes

Original Article

Journal of the Korean Ophthalmological Society 2019; 60(7): 643-653.

Published online: 15 July 2019

DOI: https://doi.org/10.3341/jkos.2019.60.7.643

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

Joo Young Kim, MD, Chang Hyun Park, MD, Woong Joo Whang, MD, PhD, Kyung Sun Na, MD, PhD, Hyun Seung Kim, MD, PhD

Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Address reprint requests to Hyun Seung Kim, MD, PhD. Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #10 63-ro, Yeongdeungpo-gu, Seoul 07345, Korea. Tel: 82-2-3779-1848, Fax: 82-2-761-6869, sara514@catholic.ac.kr

Received 14 February 2019 Revised 10 March 2019 Accepted 25 June 2019

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Aphakic eye, Dislocated intraocular lens, Retropupillary fixation, Scleral fixation

Figures and Tables

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.

Table 1

Causes of intraocular lens dislocation or aphakia

Values are presented as eyes (people).

IOL = intraocular lens; ICCE = intracapsular cataract extraction.

Table 2

Preoperative clinical characteristics of the scleral fixation group & the retropupillary iris fixation group

Values are presented as mean ± standard deviation unless otherwise indicated.

IOL = intraocular lens; logMAR = logarithm of minimal angle of resolution; D = diopter.

^*Mann Whitney U-test; ^†statistically significant differences (p < 0.05) among groups.

Table 3

Changes of autokeratometer refractive astigmatism, autokeratometer cornea front astigmatism, and Pentacam® cornea front astigmatism over time in the scleral fixation group & the retropupillary iris fixation group

Values are presented as mean ± standard deviation unless otherwise indicated.

IOL = intraocular lens; D = diopter; POD = post operative day.

^*Mann Whitney U-test; ^†Wilcoxon signed rank test; ^‡linear mixed model; ^§statistically significant differences (p < 0.05) among groups.

Table 4

Changes of corneal endothelium cell density, coefficient of variation, and hexagonality over time in the scleral fixation group & the retropupillary iris fixation group

Values are presented as mean ± standard deviation unless otherwise indicated.

IOL = intraocular lens; POD = post-operative day.

^*Mann Whitney U-test; ^†Wilcoxon signed rank test; ^‡repeated-measures analysis of variance; ^§statistically significant differences (p < 0.05) among groups.

Table 5

Postoperative complications of the scleral fixation group & the retropupillary iris fixation group

Values are presented as eyes.

IOL = intraocular lens.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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