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Aditya Kanesa-thasan, Matthew Nguyen, Brandon D. Ayres; Analysis of Visual and Refractive Outcomes of Scleral-Fixated Intraocular Lens Implants. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1339.
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Predicting refractive outcomes with scleral-fixated intraocular lens implants can be challenging. We aim to analyze visual and refractive outcomes in a consecutive series of scleral fixated lenses implanted by an experienced anterior segment surgeon.
The methods were approved by the Wills Eye Hospital IRB. A retrospective chart review examined all scleral-fixated lens implantations by a single surgeon (B.D.A.) from March 2014 to March 2017. Patients without at least 2 months of follow up were excluded. A refractive target of -0.50 sphere was chosen unless otherwise specified. Lens calculations were done using Holladay I with the appropriate lens constant for the chosen lens for placement in the capsular bag. Data was taken from preop and postop visits including age, BCVA, refraction, ocular history, type of lens, and lens power.
A total of 125 eyes from 113 patients met criteria for inclusion. Average age at surgery was 65 (range 15-95). An AO60 lens was sutured in 87 eyes (70% %), CZ70BD in 26 eyes (21%), and MX60 in 12 eyes (9%). Common reasons for surgery were lens subluxation in 59 eyes (47%), aphakia in 32 eyes (25%), and complications of ACIOL placement in 24 eyes (19%). Pseudoexfoliation was noted in 16 eyes (13%) and trauma in 25 eyes (20%). Preexisting retinal pathology was noted in 45 eyes (36%) and glaucoma was noted in 45 eyes (36%), with 20 eyes (16%) having both diagnoses. Combination DSEK/SFIOL was done for 27 eyes (22%) and PKP/SFIOL for 12 (10%). Including patients who received DSEK or PKP, preop VA averaged 0.98 logMAR (20/200 Snellen) and postop VA averaged 0.54 logMAR (20/70). Of this cohort, 71 eyes (57%) improved 2 lines or more and 39 eyes (31%) improved 6 lines or more. Excluding combination cases, mean preop VA was 0.67 logMAR (20/100 Snellen) and postop VA was 0.34 logMAR (20/40 Snellen).There were 61 eyes (49%) with recorded postop refractions. Of those who did not receive DSEK or PKP, 31 eyes (74%) had postop visual acuities of 20/40 or better. There were 20 eyes (48%) within ± 0.50 diopters of target and 30 eyes (71%) within ± 1 diopter of target.
Scleral fixated IOLs are an effective method for restoring vision in patients without capsular support. Challenges remain in achieving refractive targets using these lenses. Visual and refractive outcomes can be excellent in appropriate patients, and almost all patients benefitted from the procedure.
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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