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Abstract
Purpose
We evaluated the short-term clinical outcomes of patients who underwent modified scleral fixation of an intraocular lens (IOL) using a scleral tunnel and groove.
Methods
From June 2016 to May 2017, 34 eyes of 34 patients who underwent modified scleral fixation of an IOL using a scleral tunnel and groove were retrospectively studied. We evaluated the best-corrected visual acuity (BCVA), corneal endothelial cell density, intraocular pressure (IOP), spherical equivalent, and postoperative complications at 1 week, 1 month, 3 months, and 6 months after surgery.
Results
The BCVA was 0.85 ± 0.83 logarithm of the minimal angle of resolution (logMAR) before surgery and 0.38 ± 0.61 logMAR at 6 months (p = 0.001). The corneal endothelial cell count was 1,955.12 ± 217/mm2 and 1,852.59 ± 190/mm2, before and after surgery, respectively, which was not significantly different (p = 0.186). Postoperative complications occurred in eight eyes (23.5%); IOP elevation in one eye (2.9%), IOL tilt or decentration in two eyes (5.7%), optic capture in four eyes (11.4%), and cystic macular edema in one eye (2.9%). The spherical equivalent showed myopic changes after surgery and decreased significantly over time (p = 0.001).
Conclusions
Modified scleral fixation of the IOL using a scleral tunnel and groove improved the BCVA, but did not significantly affect corneal endothelial cell loss. This procedure can be a good alternative to conventional scleral fixation of an IOL, which has advantages in shortened surgical time and easy surgical manipulation.
References
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Figure 1.
The surgical procedure of scleral fixation of intraocular lens (IOL) through scleral tunnel and groove. (A) The 8-lines corneal marker is used to mark 1 and 7 o'clock directions from corneal center. (B) Six points on sclera are marked at 1.5 mm posterior to the limbus (point 1: at 7 o'clock direction, point 2: at 1.0 mm away from point 1 counterclockwise, point 3: 3.0 mm away from point 2 counterclockwise, point 4: at 1 o'clock direction, point 5: at 1.0 mm away from point 4 counterclockwise, point 6: 3.0 mm away from point 5 counterclockwise). (C) Two limbal parallel scleral tunnels (3.0 mm length, 1/2 scleral thickness) are made using a 23-gauge needle (one: line between point 2 and 3, the other: line between point 5 and 6). (D) Two scleral grooves 1.0 mm long are made using a stab knife (one: line between point 1 and 2, the other: line between point 4 and 5). (E) Two full-thickness scleral incisions are made using a stab knife above point 1 and 4. (F) The leading haptic is held and then pulled out of the eye through the scleral incisions using 23-gauge microforceps. (G) The both haptics are inserted into the scleral tunnel. Then, the IOL is placed into position. (H) The conjunctiva is closed with 8–0 vicryl.
Figure 2.
Complications of scleral fixation of intraocular lens (IOL) through sclera tunnel and groove. (A, B) Optic capture. (C) Cystoid macular edema. (D) IOL decentration.
Figure 3
Post-operative anterior segment optical coherence tomography (OCT). (A) A typical OCT image in the patient at 3 months after surgery. (B) OCT shows the scleral tunnel with the incarcerated haptic of the intraocular lens at 3 months. There are no signs of leakage or inflammation.
Table 1.
Characteristics of 34 patients who underwent scleral fixation of IOL with scleral tunnel and groove
Table 2.
Mean BCVA and ECD at the time of preoperation and final follow-up after surgery
| Variable | Value |
|---|---|
| Baseline BCVA (logMAR) | 0.85 ± 0.83 |
| Final follow-up BCVA (logMAR) | 0.38 ± 0.61 |
| p-value* | 0.001 |
| Baseline ECD | 1,955.12 ± 217.64 |
| Final follow-up ECD | 1,852.59 ± 190.78 |
| p-value* | 0.186 |
Table 3.
Changes of IOP and mean spherical equivalent
| Variable | Value | p-value* |
|---|---|---|
| IOP | ||
| Pre-operation | 15.68 ± 3.13 | |
| Post 1 week | 17.38 ± 6.35 | 0.617 |
| Post 1 month | 16.47 ± 3.58 | 0.679 |
| Post 3 months | 15.24 ± 4.30 | 0.726 |
| Post 6 months | 14.94 ± 3.15 | 0.702 |
| Mean spherical equivalent (diopter) | ||
| Pre-operation | 4.32 ± 7.30 | |
| Post 1 week | −1.26 ± 1.96 | 0.001 |
| Post 1 month | −0.71 ± 1.56 | 0.001 |
| Post 3 months | −0.32 ± 1.60 | 0.001 |
| Post 6 months | −0.26 ± 1.30 | 0.001 |
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