Abstract
Purpose :
To report visual results and accuracy of IOL power calculation for small gauge vitrectomy aided 4 point scleral fixated IOLs in aphakic patients
Methods :
Outcomes of 17 eyes that underwent small gauge vitrectomy assisted scleral fixation of IOL using Bausch and Lomb Akreos (4 haptic) AO60 lens and CV-8 Gore-Tex sutures were reviewed. Surgery involved needle-less introduction of sutures into the eye using intra-ocular small gauge forceps, passing sutures through the 4 haptic loops of IOL, and scleral fixation of sutures 2mm posterior to the limbus. Two month post-op best-corrected visual acuity (BCVA), intraocular pressure (IOP) and refractive error were measured. Anterior segment photography using Galilei Dual Scheimpflug Analyzer (GDSA) (Ziemer Group, Port, Switzerland) was used to measure actual IOL position post-operatively. Lens power selection formula was derived to achieve emmetropia
Results :
Patients underwent 23G (n=2), 25G (n=10) and 27G (n=5) vitrectomy-assisted scleral fixation of IOL. Indications for surgery were aphakia secondary to lensectomy after traumatic retinal detachment and open globe repair, subluxed crystalline lens after blunt trauma and dislocated IOLs. There were 5 females and 11 males. Mean age was 57yrs(±SD10, 37-82yrs). VA ranged from 20/40 to 20/20000 pre-op (LogMAR mean 1.4±SD1.0) and 20/20 to 20/20000 post-op (LogMAR mean 0.9±SD1.1). Mean improvement in VA was 1.2 Snellen lines(±SD1.2,0-3 lines), LogMAR mean 0.1(±SD 0.1,0-0.4). Mean post-op IOP was 13 mmHg (±SD 4, 7-19mmHg). Mean follow-up was 5 months (±SD 3 months). Mean post-op effective lens position, measured from corneal endothelium to anterior surface of IOL was 4.1mm (±SD 0.2, 3.6-4.3mm). Mean post-op spherical equivalent was -0.7D(±SD 0.7, -1.5 to +0.4D). There were no complications.
Conclusions :
Small gauge vitrectomy aided scleral fixation of PC-IOL for aphakic patients post trauma results in reproducible visual outcomes and no complications. To achieve emmetropia, IOL power should be reduced by +0.75-1D. Although traumatic optic neuropathy or maculopathy hindered visual outcome in some patients, this study showed that visual improvement is possible with appropriate surgical planning
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.