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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

© 2016 The Korean Ophthalmological Society

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.

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.
jkos-57-742f1.tif
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.
jkos-57-742f2.tif
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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