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Tatyana Beketova, Gene Kim; Opacification of Scleral Sutured Hydrophilic Acrylic Intraocular Lenses in Patients with Subsequent DSAEK or Pars Plana Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):443.
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© ARVO (1962-2015); The Authors (2016-present)
A new small incision 4-point scleral-sutured fixation technique utilizing a hydrophilic acrylic intraocular lens (IOL) is available. Although this technique is easier, the downside is a high rate of opacification with subsequent surgeries, especially in Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) and pars plana vitrectomy (PPV) where intraocular gas is required. The purpose of this study is to estimate this opacification rate after DSAEK and/or PPV.
Charts of patients who underwent scleral-sutured hydrophilic acrylic IOL surgery and a subsequent PPV or DSAEK between January 2011 and March 2017 were reviewed. Eyes with less than 6 months of follow-up or a scleral sutured IOL not made of hydrophilic acrylic were excluded. Preoperative data were recorded, including ocular history, best corrected visual acuity (BCVA), and slit lamp exam. Postoperative data collected included BCVA, slit lamp exam, and presence or absence of IOL opacification at 1, 3, 6 and 12 months.
12 participants were included. The mean age was 63 years (±19, range: 14-83 years) when undergoing scleral-sutured IOL surgery. An Akreos AO60 IOL (Bausch & Lomb, Rochester, NY) was implanted in all eyes with no intraoperative complications. 6 eyes (50%) underwent PPV, 3 (25%) DSAEK, and 3 (25%) both DSAEK and PPV after IOL insertion. The mean follow-up time after PPV and/or DSAEK was 16 months (± 9, range: 6 - 34 months). Of 12 eyes, 1 eye (8.3%) developed IOL opacification. This eye had undergone PPV, pars plana lensectomy, and open globe repair prior to the insertion of a scleral-sutured hydrophilic acrylic secondary IOL. After IOL insertion, the eye underwent PPV, endolaser photocoagulation, cryotherapy, IOL repositioning, and a scleral patch graft. At the 12-month visit, this eye had 1+ IOL opacification. LogMAR BCVA for all 12 eyes improved from 1.55 ± 0.60 preoperatively to 0.87 ± 0.78 at last follow-up (P=0.031).
Hydrophilic acrylic IOLs have low rates of opacification and are a reasonable option for scleral-sutured IOLs even with subsequent intraocular surgery involving gas bubble placement.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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