Short-Term Comparison of Surgical Results between One-Haptic and Two-Haptics Transscleral Fixation of Intraocular Lens

In Ho Woo; Young Wook Cho; Ji Hye Jang

doi:10.3341/jkos.2016.57.5.742

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Woo, Cho, and Jang: Short-Term Comparison of Surgical Results between One-Haptic and Two-Haptics Transscleral Fixation of Intraocular Lens

Original Article

J Korean Ophthalmol Soc 2015;57(5):742-751.

Published online: 7 September 2015

DOI: https://doi.org/10.3341/jkos.2016.57.5.742

Short-Term Comparison of Surgical Results between One-Haptic and Two-Haptics Transscleral Fixation of Intraocular Lens

In Ho Woo, MD, Young Wook Cho, MD, Ji Hye Jang, MD

Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea

Address reprint requests to Ji Hye Jang, MD Department of Ophthalmology, Daegu Fatima Hospital, #99 Ayang-ro, Dong-Gu, Daegu 41199, Korea Tel: 82-53-940-7545, Fax: 82-53-954-7417 E-mail: mjmom99@naver.com

Received 24 September 201523 March 2016 Accepted 19 April 2016

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 perm its unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the short-term clinical outcomes of transscleral fixation intraocular lens (IOL) with two haptics or one haptic.

Methods

We retrospectively reviewed the medical records of 26 patients with transscleral fixation of IOL (11 with one-haptic fixation, 15 with two-haptic fixation) except in patients whose visual acuity is not expected to improve due to retinal problems or ocular trauma. We analyzed the manifest refraction, visual acuity, refractive error preoperatively and postoperatively, preoperative IOL decentration, operating time, and postoperative complications.

Results

When comparing the two groups preoperatively, the mean lens decentration in the one-haptic group was 2.73 ± 2.88 mm and 4.59 ± 2.18 mm in the two-haptics group. The decentration in the two-haptic group was greater than in the one-haptic group, but not significantly. Visual acuity and refractive power were not significantly different between the groups. The mean operation time (minutes) was 65.00 ± 22.69 and 93.66 ± 29.54 in the one-haptic and two-haptic groups, respectively. The operation time in the one-haptic group was significantly shorter than in the two-haptic group (p = 0.020). When comparing visual acuity preoperatively and postoperatively, both groups showed significant improvement (p < 0.01). However, refractive error and postoperative IOL decentration were similar between the groups.

Conclusions

The short-term surgical results of transscleral fixation using the two surgical techniques were not different; one-haptic transscleral fixation was preferred due to shorter operation time and lower patient discomfort.

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Keywords: Dislocated intraocular lens, One-haptic fixation of intraocular lens, Transscleral fixation, Two-haptic fixation of intraocular lens

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Figure 1.

Steps of two-haptic transscleral fixation of intraocular lens (IOL). (A) Scleral flap is created at two sites. (B) A long curved double-armed 10-0 polypropylene needle is passed through the scleral flap site. (C) A 25-gauge syringe is passed from the opposite site and docked the curved needle. (D) The docked 25-gauge syringe and curved needle are moved from the scleral flap. (E) A 3.0 mm corneal incision is created at the temporal side and the 10-0 polypropylene is pulled through the corneal incision site with a Sinskey hook and is cut. (F) The 10-0 polypropylene is tied on both haptics of the IOL.

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Figure 2.

Steps of one haptic transscleral fixation of intraocular lens (IOL). (A) Scleral flap is created at one site. (B) Double-armed 10-0 polypropylene needle is cut in half, pushed through the end of the 25-gauge hollow syringe tip and the syringe is placed through the scleral flap site. (C) A 3.0 mm corneal incision is created at the temporal side and the 10-0 polypropylene is pulled through the corneal incision site. (D) The 10-0 polypropylene is tied on a one side of the haptic of the IOL.

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Table 1.

Preoperative clinical characteristics of one-haptic transscleral fixation of the intraocular lens (IOL) group

Patient	Sex/age (years)	Problem of primary cataract surgery or related procedure	IOL state or lens state	Decenter of IOL (mm)	Axial lengths (mm)	Preop UCVA (log MAR)	Preop BCVA (log MAR)	Preop refraction
1	M/69	PC rupture	Aphakia	7	22.25	2.00	0.40	Sph +13.50 -cyl 0.50 × 180°
2	M/48	PC rupture	Dropped IOL	7	23.26	1.10	0.40	Sph +12.00 -cyl 1.00 × 180°
3	M/85	PC rupture	Dropped IOL	7	22.69	2.22	0.30	Sph +13.00 -cyl 3.00 × 180°
4	M/52	IOL sulcus fixation	IOL dislocation	2.1	23.48	0.15	0.09	Sph -1.00 -cyl 3.00 × 90°
5	M/50	Zonular weakness	IOL dislocation	2.1	24.35	0.30	0.09	Sph +1.50 -cyl 0.50 × 90°
6	M/49	Posterior capsulotomy	IOL dislocation	2.1	24.87	1.40	0.04	Sph -0.50 -cyl 0.50 × 90°
7	M/65	Traumatic zonular dialysis	IOL dislocation	0.7	23.24	0.70	0.40	Sph +1.50 -cyl 2.50 × 90°
8	M/36	PC rupture	IOL dislocation	0.7	23.11	0.82	0.30	Sph -3.00 -cyl 1.00 × 180°
9	M/78	Traumatic zonular dialysis	IOL dislocation	0.7	22.88	1.00	0.52	Sph -4.25 -cyl 0.75 × 180°
10	M/33	Traumatic zonular dialysis	IOL dislocation	0.7	25.12	1.00	0.15	Sph Plano -cyl 2.00 × 90°
11	F/87	PC rupture	Phakic state	0	23.10	2.22	0.30	Sph +3.00 -cyl 0.75 × 90°

Preop = preoperative; UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity; log MAR = logarithm of the minimal angle resolution; PC = posterior capsule; Sph = spherical; cyl = cylindrical.

Table 2.

Preoperative clinical characteristics of two-haptic transscleral fixation of the intraocular lens (IOL) group

Patient	Sex/age (years)	Problem of primary cataract surgery or related procedure	IOL state or lens state	Decenter of IOL (mm)	Axial lengths (mm)	Preop UCVA (log MAR)	Preop BCVA (log MAR)	Preop refraction
1	M/79	PC rupture	Aphakia	7	23.30	2.00	1.22	Sph +13.00 -cyl 2.00 × 90°
2	M/68	Zonular dialysis	Dropped IOL	7	24.23	1.40	0.30	Sph +11.50 -cyl 1.00 × 90°
3	F/71	Zonular dialysis	Dropped IOL	7	21.50	2.00	0.04	Sph +12.50 -cyl 0.50 × 90°
4	M/62	Zonular dialysis	Dropped IOL	7	25.00	2.00	0.15	Sph +10.50 -cyl 2.00 × 90°
5	M/74	ECCE	IOL dislocation	5.6	23.72	0.70	0.52	Sph +14.00 -cyl 2.00 × 90°
6	M/50	Zonular dialysis	IOL dislocation	5.6	24.40	0.52	0.52	Sph +11.00 -cyl 3.00 × 90°
7	M/59	Zonular dialysis	IOL dislocation	5.2	23.76	0.70	0.22	Sph -1.00 -cyl 2.50 × 180°
8	M/55	ECCE	IOL dislocation	4.9	23.92	2.00	0.09	Sph +13.00 -cyl 1.00 × 90°
9	M/56	ECCE	IOL dislocation	4.9	23.98	0.52	0.52	Sph -2.00 -cyl 0.25 × 90°
10	M/69	PC rupture	IOL dislocation	4.9	23.62	0.52	0.09	Sph +10.50 -cyl 0.50 × 180°
11	M/60	Zonular dialysis	IOL dislocation	3.5	24.45	0.70	0	Sph -2.00 -cyl 0.50 × 180°
12	M/56	Zonular dialysis	IOL dislocation	2.5	23.91	0.30	0.15	Sph +1.00 -cyl 2.00 × 90°
13	M/66	Zonular dialysis	IOL dislocation	2.1	24.27	0.22	0.09	Sph +1.50 -cyl 0.50 × 90°
14	M/50	Zonular dialysis	IOL dislocation	1.75	24.29	0.40	0.15	Sph +2.25 -cyl 0.25 × 90°
15	M/76	Zonular weakness	IOL exchange	0	24.17	0.82	0.70	Sph +1.50 -cyl 0.50 × 90°

Preop = preoperative; UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity; log MAR = logarithm of the minimal angle resolution; PC = posterior capsule; ECCE = extracapsular cataract extraction; Sph = spherical; cyl = cylindrical.

Table 3.

Comparison of decentration, target diopter and operation time between the two groups

Surgical techniques	Group A (%, n = 11)	Group B (%, n = 15)	p-value^∗
Preop. IOL decentration (mm)	2.73 ± 2.82	4.59 ± 2.18	0.109
POD 3 months IOL decentration (mm)	0.50 ± 1.01	0.24 ± 0.38	0.574
Operating time (minutes)	65.00 ± 22.69	93.66 ± 29.54	0.020

Values are presented as mean ± SD unless otherwise indicated. ‘Group A’ is ‘one-haptic transscleral fixation of IOL (count hapic sulcus fixation)’, and ‘Group B’ is ‘two-haptics transscleral fixation of IOL’.

Preop. = preoperative; IOL = intraocular lens; POD = postoperative day.

^∗ Mann-Whitney U-test.

Table 4.

Comparison of the postoperative clinical outcome between the two groups

	Group A	Group B	p-value^∗
UCVA (log MAR)
Preop.	1.19 ± 0.74	0.98 ± 0.68	0.330
POD 1 day	0.60 ± 0.29^†	0.73 ± 0.47	0.646
POD 1 month	0.43 ± 0.25^†	0.52 ± 0.44^†	0.959
POD 3 months	0.36 ± 0.28^†	0.38 ± 0.31^†	0.959
BCVA (log MAR)
Preop.	0.49 ± 0.64	0.31 ± 0.32	0.413
POD 1 day	0.32 ± 0.23	0.47 ± 0.41	0.413
POD 1 month	0.15 ± 0.13^†	0.25 ± 0.40	0.799
POD 3 months	0.12 ± 0.13^†	0.12 ± 0.19^†	0.760
Mean spherical (diopter)
Preop.	3.25 ± 6.48	6.48 ± 6.28	0.330
POD 1 day	-0.15 ± 1.26	0.15 ± 1.70^†	0.799
POD 1 month	-0.50 ± 1.40	-0.15 ± 1.81^†	0.919
POD 3 months	-0.50 ± 1.37	-0.11 ± 1.28^†	0.610
Refractive error (diopter)
POD 1 day	0.15 ± 0.83	0.51 ± 1.26	0.574
POD 1 month	-0.22 ± 1.75	0.21 ± 1.39	0.443
POD 3 months	-0.18 ± 0.84	0.25 ± 0.86	0.164

Values are presented as mean ± SD unless otherwise indicated. ‘Group A’ is ‘one-haptic transscleral fixation of IOL (count hapic sulcus fixation)’ and ‘Group B’ is ‘two-haptics transscleral fixation of IOL’.

UCVA = uncorrected visual acuity; log MAR = logarithm of the minimal angle resolution; Preop. = preoperative; POD = postoperative day; BCVA = best corrected visual acuity.

^∗ Statistically significant differences (p-value < 0.05) in Mann-Whitney U-test;

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

Table 5.

Surgical techniques of one-haptic transscleral fixation of intraocular lens (IOL) group

Patient	Sex/age (years)	OP site (left/right)	IOL choice	Surgical techniques	One-hatpic fixation	OP time (minutes)
1	M/69	Left	C-flex^®	T-S fixation + Partial vitrectomy	2 o’clock	85
2	M/48	Right	Previous IOL	T-S fixation + Partial vitrectomy	10 o’clock	80
3	M/85	Left	HOYA PC60AD^®	T-S fixation + Partial vitrectomy	2 o’clock	100
4	M/52	Right	Previous IOL	T-S fixation + Partial vitrectomy	1 o’clock	55
5	M/50	Right	C-flex^®	T-S fixation + Partial vitrectomy	11 o’clock	90
6	M/49	Left	Previous IOL	T-S fixation + Partial vitrectomy	11 o’clock	45
7	M/65	Left	Previous IOL	T-S fixation + Partial vitrectomy	12 o’clock	65
8	M/36	Left	Previous IOL	T-S fixation Only	10 o’clock	40
9	M/78	Right	Previous IOL	T-S fixation Only	1 o’clock	30
10	M/33	Left	PreciSAL^®	T-S fixation + Synechiolysis	12 o’clock	50
11	F/87	Right	C-flex^®	T-S fixation Only	7 o’clock	75

OP = operation; T-S = transscleral.

Table 6.

Surgical techniques of two-haptic transscleral fixation of the intraocular lens (IOL) group

Patient	Sex/age (years)	OP site (left/right)	IOL choice	Surgical techniques	Two-haptic fixation	OP time (minutes)
1	M/79	Right	C-flex^®	T-S fixation + Partial vitrectomy	10-4 o’clock	150
2	M/68	Right	C-flex^®	T-S fixation + Partial vitrectomy	10-4 o’clock	65
3	F/71	Left	C-flex^®	T-S fixation + Partial vitrectomy	11-5 o’clock	110
4	M/62	Left	HOYA PC60AD^®	T-S fixation + Partial vitrectomy	11-5 o’clock	75
5	M/74	Left	Previous IOL	T-S fixation + Partial vitrectomy	1-7 o’clock	100
6	M/50	Left	Previous IOL	T-S fixation + Partial vitrectomy	11-5 o’clock	90
7	M/59	Left	PreciSAL^®	T-S fixation + Partial vitrectomy	11-5 o’clock	55
8	M/55	Right	Previous IOL	T-S fixation + Partial vitrectomy	10-4 o’clock	85
9	M/56	Left	C-flex^®	T-S fixation + Partial vitrectomy	10-4 o’clock	85
10	M/69	Left	C-flex^®	T-S fixation + Partial vitrectomy	11-5 o’clock	80
11	M/60	Left	C-flex^®	T-S fixation + Partial vitrectomy	1-7 o’clock	65
12	M/56	Right	C-flex^®	T-S fixation + Partial vitrectomy	11-5 o’clock	115
13	M/66	Left	Previous IOL	T-S fixation + Partial vitrectomy	1-7 o’clock	150
14	M/50	Left	C-flex^®	T-S fixation + Partial vitrectomy	11-5 o’clock	65
15	M/76	Left	C-flex^®	T-S fixation + Partial vitrectomy	1-7 o’clock	115

OP = operation; T-S = transscleral;.

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