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Jocelyn T. Kuryan, Jamie Schafer, Elaine Wu, David Ritterband, Seedor John A.; Suture Fixation of Posterior Chamber Intraocular Lenses: Indications and Outcomes. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4723.
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To assess the indications for suture-fixation of posterior chamber intraocular lenses (PCIOLs) and identify postoperative complications.
This is a retrospective interventional case review of suture-fixated PCIOLs performed by two surgeons from October 2006 to October 2010. Eyes with a prior history of a sutured PCIOL were excluded. The factors studied included indications for suture-fixation, history of trauma, number of previous intraocular surgeries and postoperative complications.
76 eyes of 74 patients were studied. The average patient age at time of surgery was 67 +/- 17 years. Iris-sutured PCIOLs were performed in 66 cases (87%) and scleral-sutured PCIOLs were implanted in the remaining 10 (13%). The average length of postoperative follow-up was 5 months (range 1-24 months). The primary indications for a sutured PCIOL were non-traumatic dislocation/subluxation of the original IOL implant (55%) and poor capsular support due to trauma (20%). Postoperative complications included subsequent dislocation of the sutured PCIOL, which was significant enough to require surgical intervention in 10 cases (13%). All cases of dislocations requiring repeat surgery occurred in eyes with iris-sutured PCIOLs. Ocular hypertension requiring initiation of intraocular pressure-lowering drops occurred in 8 cases (11%). This included 2 cases of scleral-sutured PCIOLs (18% of all scleral-sutured PCIOLs) and 6 cases of iris-sutured PCIOLs (9% of all iris-sutured PCIOLs). Retinal detachment occurred postoperatively in 1 case (1%) and vitreous hemorrhage occurred in 3 cases (4%). 7 cases (9%) developed visually significant corneal edema, but all had prior history of keratoplasty, preexisting corneal edema or trauma. A trend toward subsequent dislocation of a sutured PCIOL was noted in eyes that had more than 1 prior intraocular surgery, but this was not found to be statistically significant (p=0.20, Fisher’s exact test).
Suture fixation of PCIOLs appears to be an effective technique to treat aphakia in cases with insufficient capsular support. Rates of complication were low. Risk for subsequent dislocation of sutured PCIOLs may be directly related to the number of prior intraocular surgeries. Dislocation was more common with iris-sutured PCIOLs, as this was not observed with any scleral-sutured PCIOLs. However, a higher rate of ocular hypertension requiring therapy was observed in scleral-sutured PCIOLs.
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