Comparison of Short-term Clinical Outcomes between Scleral Fixation vs. Iris Fixation of Dislocated IOL

Youlim Lee; Min Ho Kim; Yu Li Park; Kyung Sun Na; Hyun Seung Kim

doi:10.3341/jkos.2017.58.10.1131

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Lee, Kim, Park, Na, and Kim: Comparison of Short-term Clinical Outcomes between Scleral Fixation vs. Iris Fixation of Dislocated IOL

Original Article

J Korean Ophthalmol Soc 2017;58(10):1131-1137.

Published online: 25 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.10.1131

Comparison of Short-term Clinical Outcomes between Scleral Fixation vs. Iris Fixation of Dislocated IOL

Youlim Lee, MD, Min Ho Kim, MD, Yu Li Park, MD, Kyung Sun Na, MD, PhD, Hyun Seung Kim, MD, PhD

Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Hyun Seung Kim, MD, PhD Department of Ophthalmology, The Catholic University of Korea Yeouido St. Mary's Hospital, #10, 63-ro, Yeongdeungpo-gu, Seoul 07345, Korea Tel: 82-2-3779-1243, Fax: 82-2-761-6869 E-mail: sara514@catholic.ac.kr

Received 20 April 2017 Revised 30 August 2017 Accepted 26 September 2017

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 compare clinical outcomes between iris fixation and scleral fixation as treatments for dislocated Intra Ocular Lens.

Methods

Ten eyes of 10 patients underwent scleral fixation (scleral fixation group) and 8 eyes of 8 patients underwent iris fixation (iris fixation group) were enrolled in this retrospective study. In each group, visual acuity and intra ocular pressure, slit lamp examination, fundus examination, refraction, keratometry, axial length and anterior chamber depth were measured before the surgery. Regular follow up was made 1 day, 1 week, 1 month, and 2 months after surgery and visual acuity, intra ocular pressure, slit lamp exam, refractory error, anterior chamber depth, intraocular lens (IOL) tilting, and decentration were measured at each visit.

Results

There were no significant differences in uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and refractive error for patients with iris and scleral fixation before and after surgery. Patients with iris fixation had significantly deeper anterior chamber depth (ACD) and more IOL tilting than patients with scleral fixation.

Conclusions

In this study, the iris fixation group tended to have more IOL tilting and deepening of anterior chamber depth than the scleral fixation group. We can use this information to choose the appropriate surgical method for dislocated IOL and to select of new IOL.

Keywords: Cataract, Dislocated IOL, Iris fixation, Scleral fixation

References

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Figure 1.

Representative images of dislocated intraocular lens. (A) Inferonasally tilted lens (B) Inferiorly tilted lens.

Figure 2.

Changes of Anterior chamber depth (ACD) over time after Scleral or Iris fixation of intraocular lens (mm). Patients with iris fixation had significantly deeper ACD than patients with scleral fixation. Pre-op. = pre-operative; POD = post operative day; w = week; m = month(s). ^* Values which are statistically significant.

Figure 3.

Changes of intraocular lens (IOL) tilting (°) over time after Scleral or Iris fixation of IOL. Patients with iris fixation had more IOL tilting than patients with scleral fixation. POD = post operative day; w = week; m = month(s). ^* Values which are statistically significant.

Table 1.

Preoperative clinical characteristics of Scleral fixation group & Iris fixation group

	Method of surgery		p-value
	Scleral fixation (n = 10)	Iris fixation (n = 8)	p-value
Sex	M = 8, F = 2	M = 6, F = 2
Age (years)	53.71 ± 3.80	64.67 ± 2.85	0.124
UCVA (logMAR)	1.01 ± 0.09	0.98 ± 0.31	0.374
BCVA (logMAR)	0.44 ± 0.06	0.30 ± 0.11	0.110
IOP (mmHg)	16.71 ± 1.00	19.38 ± 3.13	0.887
ACD (mm)	3.15 ± 0.25	3.72 ± 0.31	0.215
Axial length (mm)	24.65 ± 0.47	24.29 ± 0.83	0.247
Corneal endothelium (cells/mm²)	2,385.06 ± 163.70	1,960.25 ± 232.59	0.175
Refraction (D, spherical equivalent)	1.23 ± 2.51	2.21 ± 2.71	0.731

Values are presented as mean ± SD unless otherwise indicated. Mann Whitney U-test was used.

M = male; F = female; UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity; IOP = intraocular pressure; ACD = anterior chamber depth.

Table 2.

Changes of UCVA, BCVA, ACD and IOP over time in Scleral fixation group & Iris fixation group

	Method of surgery		p-value
	Scleral fixation (n = 10)	Iris fixation (n = 8)	p-value
UCVA (logmar)
Pre-op.	1.01 ± 0.09	0.98 ± 0.31	0.374
POD#1w	0.48 ± 0.05	0.81 ± 0.32	0.374
POD#1m	0.41 ± 0.04	0.69 ± 0.21	0.215
POD#2m	0.36 ± 0.03	0.63 ± 0.24	0.187
BCVA (logmar)
Pre-op.	0.44 ± 0.06	0.30 ± 0.11	0.110
POD#1w	0.25 ± 0.04	0.37 ± 0.20	0.546
POD#1m	0.22 ± 0.03	0.25 ± 0.12	0.829
POD#2m	0.19 ± 0.04	0.27 ± 0.09	0.416
ACD (mm)
Pre-op.	3.15 ± 0.25	3.72 ± 0.31	0.215
POD#1w	3.36 ± 0.11	3.95 ± 0.25	0.071
POD#1m	3.30 ± 0.12	4.30 ± 0.18	0.001^*
POD#2m	3.27 ± 0.13	4.22 ± 0.20	0.002^*
ACD diff. (mm)	0.24 ± 0.15	0.48 ± 0.23	0.032^*
IOP (mmHg)
Pre-op.	16.71 ± 1.00	19.38 ± 3.13	0.887
POD#1w	16.12 ± 0.81	21.63 ± 2.95	0.140
POD#1m	18.06 ± 0.88	19.38 ± 1.92	0.511
POD#2m	17.71 ± 1.06	18.14 ± 2.60	0.664

Values are presented as mean ± SD unless otherwise indicated. Mann Whitney U-test was used.

UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity; ACD = anterior chamber depth; IOP = intraocular pressure; Pre-op. = pre-operative; POD = post operative day; w = week; m = month(s); ACD diff. = difference between ACD of 2 month after the surgery and of preoperative.

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

Table 3.

Changes of IOL tilting, IOL decentration, Spherical equivalent error over time in Scleral fixation group & Iris fixation group

	Method of surgery		p-value
	Scleral fixation (n = 10)	Iris fixation (n = 8)	p-value
IOL tilting (°)
POD#1w	4.61 ± 0.12	7.48 ± 0.97	<0.001^*
POD#1m	4.65 ± 0.14	5.08 ± 0.27	0.101
POD#2m	4.60 ± 0.12	5.16 ± 0.19	0.024^*
IOL decentration (mm)
POD#1w	0.43 ± 0.01	0.49 ± 0.06	0.144
POD#1m	0.45 ± 0.01	0.44 ± 0.04	1.000
POD#2m	0.45 ± 0.01	0.49 ± 0.04	0.574
Spherical equivalent error (D)
POD#1w	–0.55 ± 0.27	–0.50 ± 0.26	0.698
POD#1m	–0.63 ± 0.24	–0.65 ± 0.41	0.820
POD#2m	–0.69 ± 0.19	–0.76 ± 0.59	0.820

Values are presented as mean ± SD unless otherwise indicated. Mann Whitney U-test was used.

IOL = intraocular lens; POD = post operative day; w = week; m = month(s).

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

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