Refractive Change after Transscleral Fixation of Intraocular Lens

Yong Sun Ahn; Yu Li Park; Hyun Seung Kim

doi:10.7469/JKOS.2015.56.04.548

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Ahn, Park, and Kim: Refractive Change after Transscleral Fixation of Intraocular Lens

Original Article

J Korean Ophthalmol Soc 2015;56(4):548-558.

Published online: 7 September 2015

DOI: https://doi.org/10.7469/JKOS.2015.56.04.548

Refractive Change after Transscleral Fixation of Intraocular Lens

Yong Sun Ahn, MD, Yu Li Park, MD, Hyun Seung Kim, MD, PhD

Department of Ophthalmology and Visual Science, The Catholic University of Korea College of Medicine, Seoul, Korea

￭ Address reprint requests to Hyun Seung Kim, MD, PhD Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, #10 63-ro, Yeongdeungpo-gu, Seoul 150-713, Korea Tel: 82-2-3779-1243, Fax: 82-2-761-6869 E-mail: sara514@catholic.ac.kr

Received 1 August 201418 October 2014 Accepted 23 March 2015

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.

초록

Purpose:

To evaluate the anterior chamber depth (ACD), extent of intraocular lens (IOL) tilt, and decentration and refractive error after transscleral fixation of IOL.

Methods:

We retrospectively reviewed the medical records of 17 cases with transscleral fixation of IOL (6 with aphakia, 5 with IOL dislocation, and 6 with lens subluxation). The acrylic IOL (MN60AC^®) was fixated in 12 eyes and the polymethylmethacrylate IOL (CZ70BD^®) was fixated in 5 eyes at 1.0 mm posterior from the limbus. We analyzed the ACD, extent of IOL tilt and decentration, manifest refraction, refractive error, higher order aberration, and corneal endothelium at 2 weeks, 1 month and 2 months postoperatively.

Results:

The mean ACD was 3.36 ± 0.11 mm, 3.30 ± 0.12 mm, and 3.27 ± 0.13 mm, the mean extent of IOL tilt was 4.61 ± 0.12°,4.65 ± 0.14°, and 4.60 ± 0.12° and the mean extent of IOL decentration was 0.43 ± 0.01 mm, 0.45 ± 0.01 mm, and 0.45 ± 0.01 mm at 2 weeks, 1 month and 2 months postoperatively, respectively in eyes with transscleral fixation of IOL. The ACD was shallower and the extent of IOL tilt and decentration was greater than with IOL in-the-bag insertion patients. The mean refractive errors were -0.55 ± 0.27 D, -0.63 ± 0.24 D, and -0.69 ± 0.19 D at the same period, respectively.

Conclusions:

Although postoperative refractive error is influenced by surgeon factors such as incision size, distance of fixation suture from limbus, and tightness of suture material, according to our results, an IOL 0.75 D more hyperopic than predicted should be selected in transscleral fixation of IOL at 1.0 mm posterior from the limbus. Additionally, each surgeon should assess their specific results and modify the lens calculations accordingly.

Keywords: Decentration, Intraocular lens, Refractive error, Tilt, Transscleral fixation

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Figure 1.

Scatterplot of correlation between the anterior chamber depth, IOL decentration, and IOL tilting with spherical equivalent (SE) error at postoperative 2 months in eyes with transscleral fixation of IOL. ACD = anterior chamber depth; IOL = intraocular lens.

Table 1.

Etiologies of transscleral fixation of IOL in patients of group A

Etiology	Number (%)
Aphakia	6 (35.29)
IOL dislocation	5 (29.41)
Lens subluxation
Trauma	3 (17.65)
Spontaneous	3 (17.65)
Total	17

IOL = intraocular lens.

Table 2.

Preoperative clinical characteristics of each group

		Group A (n = 17)	Group B (n = 39)	p-value
Sex (M:F)		12:5	10:29	0.124
Age (years)		53.71 ± 3.80	63.26 ± 2.01	0.348
Laterality (right eye:left eye)		11:6	20:19	0.353
UCVA (log MAR)		1.01 ± 0.09	0.51 ± 0.03	<0.001^*
BCVA (log MAR)		0.44 ± 0.06	0.38 ± 0.04	0.638
IOP (mm Hg)		16.71 ± 1.00	14.08 ± 0.48	0.021^*
Axial length (mm)		24.65 ± 0.47	23.75 ± 0.20	0.061
ACD (mm)		3.15 ± 0.25	3.17 ± 0.07	0.922
Corneal endothelium	Cell density (cells/mm²)	2,385.06 ± 163.70	2,665.46 ± 55.83	0.262
	Coefficient of variation	35.12 ± 1.52	34.13 ± 0.78	0.195
	Hexagonality	53.65 ± 2.62	53.77 ± 1.54	0.858
Keratometry (diopter)		1.47 ± 0.28	1.04 ± 0.10	0.260
Refraction (diopter)	SE	1.23 ± 2.51	-0.14 ± 0.49	0.864
	Cylinder	1.30 ± 0.15	1.17 ± 0.17	0.121

Pearson's Chi-square test was used for numeric parameters; Mann Whitney U-test was used for continuous parameters; Values are presented as mean ± SD or number; Group A: transscleral fixation of IOL, Group B: phacoemulsification and in-the-bag insertion of IOL.

UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity; IOP = intraocular pressure; ACD = anterior chamber depth; SE = spherical equivalent.

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

Table 3.

Comparison of postoperative anterior chamber depth, extent of IOL tilt, and decentration

		Group A (n = 17)	Group B (n = 39)	p-value
ACD (mm)	Preoperative	3.15 ± 0.25	3.17 ± 0.07	0.922
	POD #2 weeks	3.36 ± 0.11	4.14 ± 0.10^†	<0.001^*
	POD #1 month	3.30 ± 0.12	4.19 ± 0.09^†	<0.001^*
	POD #2 months	3.27 ± 0.13	4.23 ± 0.10^†	<0.001^*
IOL tilt (°)	POD #2 weeks	4.61 ± 0.12	1.24 ± 0.04	<0.001^*
	POD #1 month	4.65 ± 0.14	1.37 ± 0.04	<0.001^*
	POD #2 months	4.60 ± 0.12	1.30 ± 0.04	<0.001^*
IOL decentration (mm)	POD #2 weeks	0.43 ± 0.01	0.12 ± 0.01	<0.001^*
	POD #1 month	0.45 ± 0.01	0.15 ± 0.01	<0.001^*
	POD #2 months	0.45 ± 0.01	0.14 ± 0.01	<0.001^*

Mann Whitney U-test was used; Values are presented as mean ± SD; Group A: transscleral fixation of IOL, Group B: phacoemulsification and in– the-bag insertion of IOL.

IOL = intraocular lens; ACD = anterior chamber depth; POD = postoperative day.

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

^† Statistically significant differences ( p-value < 0.05) in Wilcoxon signed-rank test.

Table 4.

Comparison of postoperative refraction (mean spherical and mean cylinder) and spherical equivalent error of each group over time

		Group A (n = 17)	Group B (n = 39)	p-value
Mean spherical (diopter)	Preoperative	1.90 ± 2.52	0.43 ± 0.51	0.872
	POD #2 weeks	-0.05 ± 0.12	-0.37 ± 0.13^†	0.079
	POD #1 month	-0.26 ± 0.20	-0.51 ± 0.13^†	0.380
	POD #2 months	-0.45 ± 0.18	-0.50 ± 0.15^†	0.957
Mean cylinder (diopter)	Preoperative	-1.30 ± 0.15	-1.17 ± 0.17	0.121
	POD #2 weeks	-2.34 ± 0.26^†	-0.83 ± 0.12^†	<0.001^*
	POD #1 month	-1.93 ± 0.26^†	-0.84 ± 0.12^†	<0.001^*
	POD #2 months	-1.63 ± 0.20	-0.90 ± 0.11	0.001^*
Spherical equivalent error (diopter)	POD #2 weeks	-0.55 ± 0.27	-0.03 ± 0.08	0.022^*
	POD #1 month	-0.63 ± 0.24	-0.17 ± 0.07	0.022^*
	POD #2 months	-0.69 ± 0.19	-0.20 ± 0.08	0.018^*
Astigmatism (algebraic value)(diopter)	Preoperative	-0.02 ± 0.37	-0.21 ± 0.26	0.867
	POD #2 weeks	2.19 ± 0.33^†	-0.22 ± 0.18	<0.001^*
	POD #1 month	1.84 ± 0.29^†	-0.17 ± 0.18	<0.001^*
	POD #2 months	1.15 ± 0.35^†	-0.32 ± 0.17	0.001^*

Mann Whitney U-test was used; Values are presented as mean ± SD; Group A: transscleral fixation of IOL, Group B: phacoemulsification and in-the-bag insertion of IOL.

POD = postoperative day.

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

^† Statistically significant differences ( p-value < 0.05) in Wilcoxon signed-rank test.

Table 5.

Comparison of corneal astigmatism by Pentacam® of each group over time

		Group A (n = 17)		Group B (n = 39)		p-value
		WTR	ATR	WTR	ATR	p-value
Keratometry (Pentacam®)(diopter)	Preoperative	0.86 ± 0.16	1.15 ± 0.24	0.92 ± 0.14	1.08 ± 0.14	0.673/0.834
	POD #2 weeks	2.01 ± 0.24^†	1.05 ± 0.15	1.02 ± 0.15	1.14 ± 0.15	0.002^*/0.842
	POD #1 month	1.63 ± 0.21	1.70 ± 0.61	0.91 ± 0.13	0.98 ± 0.12	0.010^*/0.145
	POD #2 months	1.37 ± 0.16	1.30 ± 0.43	1.01 ± 0.10	1.15 ± 0.16	0.067/0.763

Mann Whitney U-test was used; Values are presented as mean ± SD; Group A: transscleral fixation of IOL, Group B: phacoemulsification and in– the-bag insertion of IOL.

WTR = with-the-rule; ATR = against-the-rule; POD = postoperative day.

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

^† Statistically significant differences ( p-value < 0.05) in Wilcoxon signed-rank test.

Table 6.

Comparison of postoperative outcomes by the type of IOL used in patients with transscleral fixation of IOL

		MN60AC® (n = 12)	CZ70BD® (n = 5)	p-value
BCVA (log MAR)	Preoperative	0.46 ± 0.09	0.38 ± 0.08	0.914
	POD #1 day	0.34 ± 0.08	0.40 ± 0.09	0.558
	POD #2 weeks	0.24 ± 0.06	0.28 ± 0.02	0.484
	POD #1 month	0.20 ± 0.04	0.26 ± 0.02	0.381
	POD #2 months	0.18 ± 0.04	0.22 ± 0.06	0.662
ACD (mm)	Preoperative	2.83 ± 0.29	3.35 ± 0.78	0.692
	POD #2 weeks	3.77 ± 0.10	3.12 ± 0.34	0.077
	POD #1 month	3.68 ± 0.11	2.98 ± 0.33	0.077
	POD #2 months	3.86 ± 0.21	3.00 ± 0.32	0.077
IOL tilting (°)	POD #2 weeks	5.27 ± 0.17	5.24 ± 0.23	0.811
	POD #1 month	5.32 ± 0.17	5.37 ± 0.15	1
	POD #2 months	5.33 ± 0.17	5.38 ± 0.14	1
IOL decentration (mm)	POD #2 weeks	0.56 ± 0.01	0.57 ± 0.01	0.469
	POD #1 month	0.56 ± 0.01	0.57 ± 0.01	0.371
	POD #2 months	0.56 ± 0.01	0.57 ± 0.01	0.469
Mean cylinder (diopter)	Preoperative	-1.30 ± 0.11	-1.50 ± 0.25	0.389
	POD #2 weeks	-2.45 ± 0.27	-3.33 ± 0.60	0.149
	POD #1 month	-1.83 ± 0.33	-2.83 ± 0.79	0.167
	POD #2 months	-1.35 ± 0.25	-2.25 ± 0.50	0.058
Astigmatism (algebraic value) (diopter)	Preoperative	-0.10 ± 0.45	-0.33 ± 1.06	1
	POD #2 weeks	2.20 ± 0.45	3.33 ± 0.60	0.149
	POD #1 month	1.68 ± 0.41	2.83 ± 0.79	0.167
	POD #2 months	0.53 ± 0.48	2.25 ± 0.50	0.061

Mann Whitney U-test was used; Values are presented as mean ± SD.

BCVA = best corrected visual acuity; ACD = anterior chamber depth; IOL = intraocular lens; POD = postoperative day.

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