Astigmatic Changes and Clinical Outcomes after Scleral Fixation of IOL

Shin Yeop Oh; Sang Soo Kim

doi:10.3341/jkos.2014.55.10.1452

Journal List > J Korean Ophthalmol Soc > v.55(10) > 1009803

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Oh and Kim: Astigmatic Changes and Clinical Outcomes after Scleral Fixation of IOL

Original Article

J Korean Ophthalmol Soc 2014;55(10):1452-1459.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.10.1452

Astigmatic Changes and Clinical Outcomes after Scleral Fixation of IOL

Shin Yeop Oh, MD, Sang Soo Kim, MD

Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea

Address reprint requests to Sang Soo Kim, MD, Department of Ophthalmology, Maryknoll Medical Center, #121 Junggu-ro, Jung-gu, Busan 600-730, Korea, Tel: 82-51-461-2469, Fax: 82-51-462-3534 E-mail: eyerheu@hanafos.com

Received 28 December 2013 Revised 5 June 2014 Accepted 5 September 2014

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 evaluate the clinical outcomes, complications and surgically induced astigmatism (SIA) after scleral fixation in patients with intraocular lens (IOL) or crystalline lens dislocation.

Methods

The present study retrospectively investigated the postoperative best corrected visual acuity (BCVA), refractory change, corneal astigmatism, clinical outcomes, and influencing factors of SIA in 57 eyes of 55 patients with a follow-up of 6 months after the IOL scleral fixation.

Results

In comparison of preoperative and postoperative 6 months, BCVA, spherical equivalent and astigmatism were significantly improved but corneal astigmatism was not and SIA (diopter, D) improved from 2.10 ± 1.88 D to 0.86 ± 0.73 D (p = 0.002). 4 eyes having redislocation were repositioned and 4 eyes having tilted IOL, 6 eyes having elevated intraocular pressure, 3 eyes having exposure scleral knots, 1 eye having endophthalmitis, and 1 eye showing macular edema were observed. At postoperative 3 months, the SIA of a large incision size (>3 mm) and small incision size (≤3 mm) was significantly differented (p = 0.041). According to the location of scleral fixation, SIA at postoperative 1 month was significantly different but, was not different at postoperative 6 months.

Conclusions

Surgical management of dislocated IOLs or crystalline lens resulted in significant improvement of visual acuity and absence of influencing SIA factors. However, location of scleral fixation and small incision size influenced corneal astigmatism. J Korean Ophthalmol Soc 2014;55(10):1452-1459

Keywords: Dislocated IOL, Dislocated lens, IOL reposition, Scleral fixation, Surgically induced astigmatism

References

1. Pallin SL, Walman GB. Posterior chamber intraocular lens implant centration: In or out of “the bag”. J Am Intraocular Implant Soc. 1982; 8:254–7.

2. Stark WJ Jr, Maumenee AE, Datiles M, et al. Intraocular lenses: complications and visual results. Trans Am Ophthalmol Soc. 1983; 81:280–309.

3. Smith SG, Lindstrom RL. Malpositioned posterior chamber lenses: etiology, prevention, and management. J Am Intraocul Implant Soc. 1985; 11:584–91.

4. Smiddy WE, Ibanez GV, Alfonso E, Flynn HW Jr. Surgical management of dislocated intraocular lenses. J Cataract Refract Surg. 1995; 21:64–9.

5. Mello MO Jr, Scott IU, Smiddy WE, et al. Surgical management and outcomes of dislocated intraocular lenses. Ophthalmology. 2000; 107:62–7.

6. Koh HJ, Kim CY, Lim SJ, Kwon OW. Scleral fixation technique using 2 corneal tunnels for a dislocated intraocular lens. J Cataract Refract Surg. 2000; 26:1439–41.

7. Cho SH, Kang SW, Jung MS. Four cases of modification of scleral fixation using 30 G needle for posterior chamber intraocular lens dislocation. J Korean Ophthalmol Soc. 2002; 43:917–21.

8. Chan CC, Crandall AS, Ahmed II. Ab externo scleral suture loop fixation for posterior chamber intraocular lens decentration: clinical results. J Cataract Refract Surg. 2006; 32:121–8.

9. Jehan FS, Mamalis N, Crandall AS. Spontaneous late dislocation of intraocular lens within the capsular bag in pseudoexfoliation patients. Ophthalmology. 2001; 108:1727–31.

10. Carlson AN, Stewart WC, Tso PC. Intraocular lens complications requiring removal or exchange. Surv Ophthalmol. 1998; 42:417–40.

11. Güell JL, Barrera A, Manero F. A review of suturing techniques for posterior chamber lenses. Curr Opin Ophthalmol. 2004; 15:44–50.

12. Ma DJ, Kim MK, Wee WR. Knotless external fixation technique for posterior chamber intraocular lens transscleral fixation: A 5-case analysis. J Korean Ophthalmol Soc. 2012; 53:1609–14.

13. Jung MO, Koh JW. Clinical results of modified Ab externo and one-knot technique. J Korean Ophthalmol Soc. 2012; 53:1783–8.

14. Lee DG, Nam KY, Kim JY. Modified scleral fixation of dislocated posterior chamber intraocular lenses. J Korean Ophthalmol Soc. 2009; 50:1071–5.

15. Naeser K, Hjortdal J. Polar value analysis of refractive data. J Cataract Refract Surg. 2001; 27:86–94.

16. Hill W. Expected effects of surgically induced astigmatism on AcrySof toric intraocular lens results. J Cataract Refract Surg. 2008; 34:364–7.

17. Michaeli A, Assia EI. Scleral and iris fixation of posterior chamber lenses in the absence of capsular support. Curr Opin Ophthalmol. 2005; 16:57–60.

18. Por YM, Lavin MJ. Techniques of intraocular lens suspension in the absence of capsular/zonular support. Surv Ophthalmol. 2005; 50:429–62.

19. Hayashi K, Hirata A, Hayashi H. Possible predisposing factors for in-the-bag and out-of-the-bag intraocular lens dislocation and outcomes of intraocular lens exchange surgery. Ophthalmology. 2007; 114:969–75.

20. Nikeghbali A, Falavarjani KG. Modified transscleral fixation technique for refixation of dislocated intraocular lenses. J Cataract Refract Surg. 2008; 34:743–8.

21. Grehn F, Sundmacher R. Fixation of posterior chamber lenses by transscleral sutures: technique and preliminary results. Arch Ophthalmol. 1989; 107:954–5.

22. Jang BH, Ahn M, Lee DW, Cho NC. The role of vitrectomy in transscleral fixation of posterior chamber intraocular lens. J Korean Ophthalmol Soc. 2005; 46:466–71.

23. Lee SJ, Kim KC, Hong YJ. Implantation of posterior chamber intraocular lens by trans - scleral fixation. J Korean Ophthalmol Soc. 1992; 33:704–10.

24. Roger FS. Cataract surgery technique, complications, management. 2nd ed.Saunders;2004. p. 413–6.

25. Taskapili M, Gulkilik G, Engin G, et al. Transscleral fixation of a single-piece hydrophilic foldable acrylic intraocular lens. Can J Ophthalmol. 2007; 42:256–61.

26. Merriam JC, Zheng L, Merriam JE, et al. The effect of incisions for cataract on corneal curvature. Ophthalmology. 2003; 110:1807–13.

27. Kammann J, Dornbach G, Allmers R. [Sutureless wound adaptation. Comparison between corneal and corneoscleral incision]. Ophthalmologe. 1994; 91:442–5.

28. Vote BJ, Tranos P, Bunce C, et al. Long-term outcome of combined pars plana vitrectomy and scleral fixated sutured posterior chamber intraocular lens implantation. Am J Ophthalmol. 2006; 141:308–12.

29. Ma DJ, Choi HJ, Kim MK, Wee WR. Clinical comparison of ciliary sulcus and pars plana locations for posterior chamber intraocular lens transscleral fixation. J Cataract Refract Surg. 2011; 37:1439–46.

Figure 1.

Changes of best corrected visual acuity (BCVA), astigmatism, corneal astigmatism and surgically induced astigmatism (SIA) in scleral fixation of intraocular lens (IOL).

Table 1.

Baseline characteristics of patient with scleral fixation of IOL

Baseline characteristics	Number	p-value
Number of eyes (patients)	57 (55)
M:F (number of eyes)	38 (39):17 (18)
Age (years) (range)	58.12 ± 14.00 (19-89)
Preoperative UCVA (log MAR)	1.03 ± 0.60
Preoperative BCVA (log MAR)	0.71 ± 0.60	0.000^*
Posteoperative BCVA (log MAR)	0.25 ± 0.32

Values are presented as mean ± SD.

IOL = intraocular lens; UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity.

^* Paired t-test.

Table 2.

Comparision of BCVA, spherical equivalent, astigmatism, and corneal astigmatism before and after management

	Preop	1 week	1 month	3 months	6 months
BCVA (log MAR)	0.71 ± 0.60	0.59 ± 0.52	0.42 ± 0.46	0.31 ± 0.42	0.25 ± 0.32
p-value	0.71 ± 0.60	0.188^*	0.001^*	0.000^*	0.000^*
Spherical equivalent (diopter)	5.52 ± 7.13	−2.05 ± 1.62	−2.10 ± 1.46	−1.87 ± 1.64	−1.68 ± 1.50
p-value		0.000^*	0.000^*	0.000^*	0.000^*
Astigmatism (diopter)	2.36 ± 2.23	3.29 ± 2.86	2.21 ± 1.73	1.73 ± 1.17	1.67 ± 1.04
p-value		0.028^*	0.650^*	0.028^*	0.008^*
Corneal astigmatism (diopter)	1.32 ± 1.21	2.73 ± 2.38	1.72 ± 1.33	1.43 ± 1.07	1.33 ± 0.83
p-value		0.000^*	0.001^*	0.274^*	0.952^*

Values are presented as mean ± SD.

BCVA = best corrected visual acuity.

^* Paired t-test.

Table 3.

Comparision of surgically-induced corneal astigmatism in various factors

Eyes (n)	1 week	1 month	3 months	6 months
Total SIA (diopter)	2.10 ± 1.88	1.20 ± 1.33	1.06 ± 1.20	0.86 ± 0.73
Trauma (15)	2.09 ± 1.40	1.22 ± 1.19	0.87 ± 0.98	1.03 ± 0.97
No trauma (42)	2.10 ± 2.04	1.20 ± 1.40	1.12 ± 1.27	0.80 ± 0.62
p-value	0.520^*	0.758^*	0.289^*	0.189^*
Vitrectomy (18)	1.80 ± 1.59	1.26 ± 1.58	0.73 ± 0.44	0.77 ± 0.40
No vitrectomy (39)	2.23 ± 2.00	1.17 ± 1.23	1.20 ± 1.40	0.90 ± 0.84
p-value	0.460^*	0.817^*	0.542^*	0.655^*
Pseudophakic (26)	2.25 ± 1.86	1.33 ± 1.80	1.09 ± 1.37	0.93 ± 0.92
Phakic (17)	2.53 ± 2.26	1.14 ± 0.96	0.97 ± 1.11	0.89 ± 0.64
Aphakic (14)	1.26 ± 1.02	1.04 ± 0.62	1.11 ± 1.05	0.71 ± 0.41
p-value	0.109^†	0.611	0.621	0.584^†
IOL exchange (9)	2.56 ± 2.50	2.14 ± 2.61	1.38 ± 1.95	0.99 ± 0.69
No IOL exchange (17)	1.63 ± 1.41	0.93 ± 0.99	0.92 ± 0.93	0.84 ± 1.00
p-value	0.434^*	0.500^*	0.553^*	0.306^*
Ab externo (26)	1.88 ± 1.84	1.36 ± 1.37	1.06 ± 0.90	0.91 ± 0.62
Ab interno (31)	2.28 ± 1.92	1.07 ± 1.31	1.05 ± 1.42	0.82 ± 0.82
p-value	0.332^*	0.145^*	0.140^*	0.156^*
Incision size > 3 mm (30)	2.39 ± 1.95	1.47 ± 1.71	1.39 ± 1.54	1.02 ± 0.92
Incision size ≤ 3 mm (27)	1.77 ± 1.77	0.91 ± 0.61	0.68 ± 0.43	0.69 ± 0.37
p-value	0.141^*	1.581^*	0.041^*	0.366^*
Fixation (o'clock) 3-9 (8)	1.87 ± 1.32	1.82 ± 2.00	0.69 ± 0.33	0.57 ± 0.33
6-12 (22)	1.65 ± 1.42	0.70 ± 0.55	1.07 ± 1.18	0.79 ± 0.46
5-11 (OD), 1-7 (OS) (14)	2.67 ± 2.32	1.26 ± 1.29	0.94 ± 1.02	0.92 ± 1.04
1-7 (OD), 5-11 (OS) (13)	1.37 ± 2.28	1.61 ± 1.65	1.38 ± 1.19	1.11 ± 0.87
p-value	0.522^†	0.033^†	0.692^†	0.612^†

Values are presented as mean ± SD.

SIA = surgically-induced astigmatism; IOL = intraocular lens.

^* Mann-Whitney test;

^† Kruskall-Wallis test.

Table 4.

Postoperative complications after management

Eyes (n)	Vitrectomy	IOL exchange	Ab externo:Ab interno	Trauma
Macular edema (1)	0	0	1:0	0
Optic capture (2)	1	1	1:1	0
Suture knot exposure (3)	1	0	3:0	2
IOP elevation (6)	0	0	3:3	3
Endophthalmitis & RRD (1)	0	1	1:0	0
IOL tilting (4)	2	1	4:0	1
IOL redislocation (4)	3	2	2:2	1
Total (21)	7	5	15:6	7

IOL = intraocular lens; IOP = intraocular pressure; RRD = rhegmatogenous retinal detachment.

TOOLS

Similar articles