Long-Term Results of Transscleral Fixation of Posterior Chamber Intraocular Lens

Jong Rok Oh; Ohn Young-Hoon

doi:10.3341/jkos.2016.57.1.43

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Oh and Young-Hoon: Long-Term Results of Transscleral Fixation of Posterior Chamber Intraocular Lens

Original Article

Journal of the Korean Ophthalmological Society 2015; 57(1): 43-49.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2016.57.1.43

Long-Term Results of Transscleral Fixation of Posterior Chamber Intraocular Lens

Jong Rok Oh, M.D, Ohn Young-Hoon, MD, PhD

Department of Ophthalmology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea

Address reprint requests to Young-Hoon Ohn, MD, PhD Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, #170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea Tel: 82-32-621-5425, Fax: 82-32-621-5435 E-mail: yhohn@schmc.ac.kr

‗ This study was presented as a poster at the 112th Annual Meeting of the Korean Ophthalmological Society 2014.

Received 30 April 201518 August 2015 Accepted 15 October 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.

Abstract

Purpose

To investigate the long-term results of transscleral fixation of posterior chamber intraocular lens (IOL) for unstable pos-terior capsular supporting structure.

Methods

We performed a retrospective review of 67 patients (67 eyes) with unstable posterior capsular supporting structure who underwent transscleral fixation at Soonchunhyang University Bucheon Hospital from March 2005 to January 2013. Transscleral fixation without scleral flap was performed by a single surgeon. We analyzed the causes of transscleral fixation and compared postoperative best-corrected visual acuity (BCVA) and spherical diopter.

Results

Among the 67 eyes of 67 patients, the causes of transscleral fixation included IOL subluxation (33 cases, 49.2%), IOL dislocation (11 cases, 16.4%), intraoperative posterior capsule rupture (8 cases, 11.9%), aphakia associated with previous intra-ocular surgery (7 cases, 10.4%), crystalline lens disorder with zonular dialysis (4 cases, 5.9%) and IOL opacity (4 cases, 5.9%). The mean BCVA before surgery was 1.26 ± 0.94 (log MAR) and the visual acuity improved to 0.59 ± 0.71, 0.60 ± 0.69, 0.58 ±0.70, 0.55 ± 0.70, 0.60 ± 0.58 and 0.66 ± 0.70 (1 week, 1 month, 3 months, 1 year, 3 years and 5 years, respectively, after the surgery; p < 0.05).

Conclusions

Posterior chamber IOL transscleral fixation in unstable posterior capsular supporting structure is effective for in-creasing visual acuity and spherical diopter. Specifically, the most improvement was observed at one month after surgery. Transscleral fixation is an adequate surgical procedure for fast improvement of visual acuity with long-term effects.

Keywords: Transscleral fixation

References

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Figure 1.

Knot location of posterior chamber intraocular lens transscleral fixation. (A, B) A polypropylene is fixed in the outer one-third point of haptic.

Figure 2.

Technique for the ab externo approach of posterior chamber intraocular lens (IOL) transscleral fixation. (A) The long curved double-armed 10-0 polypropylene needle is passed through the sclera approximately 1.0 mm posterior to the limbus. A sec-ond hollow needle is passed from the opposite side of the eye. (B) A hook is used to pull the suture out through a superior scleral tunnel wound so that it can be tied to the intraocular lens. (C) Suture is cut, and each end is tied to a haptic of the intraocular lens. After the IOL is placed into position. (D) The scleral sutures must be anchored to the sclera.

Figure 3.

BCVA and refractive indexes change after surgery. The mean BCVA before surgery was 1.26 ± 0.94 (log MAR) and the visual acuity improved to 0.66 ± 0.70 at 5 years after the surgery. The spherical diopter before surgery was 5.80 ±5.86 diopters and it improved to 0.56 ± 1.12 diopters at 5 years after the surgery. The cylindrical diopter change shows no significant value. BCVA = best corrected visual acuity.

Figure 4.

IOP change after surgery. After surgery, there were 33 cases of transient ocular hypertension and 5 cases of tran-sient ocular hypotension. At first day after surgery, the aver-age of ocular hypertension was 33.0 ± 12.42 mm Hg and average of ocular hypotension was 7.8 ± 0.83 mm Hg. The abnormal range of intraocular pressure was controlled within 1 month by conservative treatment. IOP = intraocular pressure.

Table 1.

Causes for scleral fixation of the posterior chamber IOL

	Case (n)
Phakia	Zonular dialysis with crystalline lens drop	2
	Zonular dialysis without crystalline lens drop	2
	Posterior capsule rupture during intraocular surgery	8
Pseudophakia	IOL dislocation	11
	IOL subluxation	33
	IOL opacity	4
Aphakia	Trauma	7

IOL = intraocular lens.

Table 2.

Patients’ characteristics

Age (years)		Sex ratio (male/female)	Follow-up period (months)
Mean ± SD	Range	Number	Mean ± SD	Range
65.56 ± 13.52	18-89	46/21	39.47 ± 27.47	10-105

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

Table 3.

BCVA and refractive indexes change after surgery

	Preoperative (n = 67)	1 week after surgery (n = 67)	1 month after surgery (n = 67)	3 months after surgery (n = 67)	1 year after surgery (n = 66)	3 years after surgery (n = 27)	5 years after surgery (n = 15)
Mean BCVA (log MAR)	1.26 ± 0.94	0.59 ± 0.71	0.60 ± 0.69	0.58 ± 0.70	0.55 ± 0.70	0.60 ± 0.58	0.66 ± 0.70
p-value^*		<0.05	<0.05	<0.05	<0.05	<0.05	<0.05
Mean Sph (D)	5.80 ± 5.86	0.49 ± 1.70	0.18 ± 1.60	0.28 ± 1.36	0.26 ± 1.37	0.43 ± 1.64	0.56 ± 1.12
p-value^*		<0.05	<0.05	<0.05	<0.05	<0.05	<0.05
Mean Cyl (-D)	1.71 ± 2.95	2.61 ± 1.77	2.24 ± 1.21	2.18 ± 1.18	2.20 ± 1.12	1.95 ± 1.09	1.89 ± 1.34
p-value^*		<0.05	0.176	0.213	0.128	0.160	0.145

Values are presented as mean ± SD unless otherwise indicated. BCVA = best corrected visual acuity; Sph = spherical refraction; Cyl = cylindrical refraction; D = diopter.

^* Paired t-test.

Table 4.

Postoperative complications after surgery

	Prevalence
Transient ocular hypertension	33 (49.25)
Transient ocular hypotension	5 (7.46)
Glaucoma	5 (7.46)
Retinal detachment	4 (5.97)
Knot exposure	3 (4.47)
Hyphema	2 (2.98)
IOL subluxation	2 (2.98)
Bullous keratopathy	1 (1.49)
Vitreous hemorrhage	1 (1.49)
Endophthalmitis	0 (0)

Values are presented as n (%). IOL = intraocular lens.

Table 5.

Intraocular pressure change after surgery

	Preoperative	1 day after surgery	1 week after surgery	1 month after surgery
Transient ocular hypertension (mm Hg, n = 33)	15.93 ± 2.34	33.0 ± 12.42	18.81 ± 7.20	13.96 ± 2.98
p-value^*		<0.05	0.110	0.353
Transient ocular hypotension (mm Hg, n = 5)	15.20 ± 2.38	7.8 ± 0.83	14.8 ± 10.28	13.8 ± 1.92
p-value^†		<0.05	0.500	0.416

Values are presented as mean ± SD unless otherwise indicated.

^* Paired t-test;

^† Wilcoxon sign rank test.

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