Clinical Outcomes of Combined Vitrectomy and Intrascleral Fixation of New Intraocular Lenses in In-the-bag Dislocations

Min Soo Lee; Sue Hey Chae; Chan Woo Bang; Hye Min Jeon; Hee Seong Yoon

doi:10.3341/jkos.2018.59.7.657

Journal List > J Korean Ophthalmol Soc > v.59(7) > 1098735

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Lee, Chae, Bang, Jeon, and Yoon: Clinical Outcomes of Combined Vitrectomy and Intrascleral Fixation of New Intraocular Lenses in In-the-bag Dislocations

Original Article

J Korean Ophthalmol Soc 2018;59(7):657-664.

Published online: 25 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.7.657

Clinical Outcomes of Combined Vitrectomy and Intrascleral Fixation of New Intraocular Lenses in In-the-bag Dislocations

Min Soo Lee, MD, Sue Hey Chae, MD, Chan Woo Bang, MD, Hye Min Jeon, MD, Hee Seong Yoon, MD, PhD

Sungmo Eye Hospital, Busan, Korea

Address reprint requests to Hee Seong Yoon, MD, PhD Sungmo Eye Hospital, #409 Haeun-daero, Haeundae-gu, Busan 48064, Korea Tel: 82-51-743-0775, Fax: 82-51-743-0776 E-mail: heesyoon@dreamwiz.com

Received 14 February 2018 Revised 9 May 2018 Accepted 22 June 2018

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 clinical outcomes of combined vitrectomy and intrascleral fixation of a new posterior chamber intraocular lens (PC IOL) as a treatment for IOL dislocation.

Methods

We conducted a retrospective interventional study at our medical facility from January 2015 to January 2017. Posteriorly dislocated IOLs were removed with pars plana vitrectomy. Two intrascleral tunnels, 2.0 mm in length, were created 1.5 mm to the limbus at 6 and 12 o'clock positions. Both haptics of new foldable acrylic 3-piece IOLs were inserted into the tunnel until the IOL was secured in a central position. We analyzed the preexisting ocular condition, visual acuity (VA), and refractive error preoperatively and postoperatively, and recorded postoperative complications.

Results

Forty-nine patients (50 eyes) were enrolled in the study. The mean follow-up period was 12.8 ± 6.6 months. A best-cor-rected VA of 6/12 or better was achieved in 43 eyes (86%). The mean VA significantly improved from 0.32 logarithm of the mini-mum angle of resolution (logMAR) at baseline to 0.18 logMAR at last follow-up (p = 0.03). The refractive status after intrascleral fixation of the PC IOL revealed a mean hyperopic shift of +1.09 ± 1.28 diopters from the predicted spherical equivalent. Postoperative vitreous hemorrhages occurred in six cases and were cleared without visual compromise. Cystoid macular edema was well-controlled by topical nonsteroidal anti-inflammatory drugs (NSAID) medications in two cases. In two cases, IOL dislocation recurred and required re-operation. There were no serious adverse events of suture-related complications, retinal detachment, corneal compromise, or endophthalmitis in any of the patients.

Conclusions

Our data revealed that use of combined vitrectomy and intrascleral fixation of PC IOLs is a safe and efficient technique to correct IOL dislocation. We observed good visual outcomes with only minor complications.

Keywords: Intraocular lens dislocation, Intrascleral fixation, Pars plana vitrectomy, Posterior chamber intraocular lens

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Figure 1.

Technique for the intrascleral fixation of intraocular lens (IOL). (A) Scleral tunnel created 1.5 mm from the limbus using a paracentesis incision diamond knife. Detailed view (inset) of the diamond knife. (B) Transscleral incision created perpendicular to the scleral tunnel. 3-dimensional view (inset) of the scleral tunnel and transscleral incision. (C) The leading haptic of the secondary IOL is grasped with 23-gauge intraocular forceps. (D) The leading haptic is pulled through the transscleral incision, and left externalized. (E) The McPherson forceps grasps the externalized tip, inserts the IOL haptic into the tunnel. (F) The tailing haptic is then inserted into the second scleral tunnel, and the two tunnels were closed in a conventional manner.

Figure 2.

Mean best corrected visual acuity (BCVA) changes after surgery. The mean BCVA before surgery was 0.34 ± 0.47 (logMAR) and the BCVA improved to 0.18 ± 0.32 at final follow-up. Note the temporary deterioration of BCVA at the first month after surgery. PreOP = preoperative; POD = postoperative day; m = month(s). *Paired t-test.

Table 1.

Preoperative clinical characteristics

Characteristic	Data
No. of eyes (patients)	50 (49)
Age (years) (range)	62.1 ± 9.7 (44–80)
Sex (male/female)	42/7
Time to IOL dislocation (years) (range)	11.3 ± 7.3 (0.1–28.0)
Follow-up (months) (range)	12.8 ± 6.6 (6–27)
Axial length (mm) (range)	24.3 ± 1.8 (21.54–30.30)
BCVA (logMAR)	0.34 ± 0.47
IOP (mmHg)	16.0 ± 5.1
ECD (cells/mm²)	2,316.1 ± 541.5
Refraction (SE, diopter)	+8.3 ± 4.4

Values are presented as mean ± SD (range) unless otherwise indicated.

IOL = intraocular lens; BCVA = best corrected visual acuity; IOP = intraocular pressure; ECD = endothelial cell density; SE = spherical equivalent.

Table 2.

Changes of BCVA, IOP, ECD and refraction after surgery

	Baseline	Final	p-value^*
BCVA (logMAR)	0.34 ± 0.47	0.18 ± 0.32	0.03
IOP (mmHg)	16.0 ± 5.1	14.4 ± 3.3	0.01
ECD (cells/mm²)	2,316.1 ± 541.5	2,206.5 ± 536.0	0.00
Refraction (SE, diopter)	+8.3 ± 4.4	−0.2 ± 1.8	0.00

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity; IOP = intraocular pressure; ECD = endothelial cell density; SE = spherical equivalent.

^* Paired t-test.

Table 3.

Postoperative complications

Complications	No. Eyes (%)
Early complications
Vitreous hemorrhage	6 (12)
Hypotony	2 (4)
IOP elevation	2 (4)
IOL dislocation	2 (4)
Late complications (>1 month)
CME	2 (4)

Values are presented as n (%).

IOP = intraocular pressure; IOL = intraocular lens; CME = cystoid macular edema.

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