Abstract
Purpose :
Scleral fixation of a posterior chamber intraocular lens (IOL) may be preferential to angle supported or iris-fixated anterior chamber IOLs when capsular support is compromised. The IOL is in a more physiological position and not in close proximity to the corneal endothelium, trabecular meshwork or iris. However, suturing haptics to the scleral wall is typically more demanding and time consuming than insertion of an anterior chamber IOL (ACIOL). A recently described sutureless scleral-fixation technique is characterised by the construction of an enlarged flange at the haptic tip, securing the haptic in a 30 gauge sclerotomy. We report the outcomes of our first 100 consecutive Yamane scleral fixated intraocular procedures performed by consultants and fellows in the vitreoretinal unit (VRU) of the Royal Victorian Eye and Ear Hospital.
Methods :
A retrospective case series examined all Yamane scleral fixated IOLs performed between 2017-2018. Pre-, intra- and post-operative data were collected, including baseline visual acuity, surgical indication, biometry, refractive outcome, visual outcome and surgical complications. Patients were followed up to their most recent post-op appointment (minimum 30 days).
Results :
A total of 111 eyes of 108 patients with a mean age of 68.4 yrs were included with a follow up of range of 30-387 days. Indications included subluxed/dislocated IOL (65%), aphakia (19%), subluxed/dislocated crystalline lens (7.4%), dropped crystalline lens (4.6%) and uveitis-glaucoma-hyphaema syndrome (1.9%). Post-operative refraction demonstrated 46%, 73% and 88% of patients were within 0.5 D, 1.0 D and 1.5 D of their predicted refractive target respectively. Early complications included elevated intraocular pressure (IOP) (13%), vitreous haemorrhage (4%), corneal oedema (7.4%) and optic capture (3.2%). Late complications (>1 month post-op) included persistent elevated IOP (10%), cystoid macular oedema (11%), and ongoing iris capture (3%).
Conclusions :
Promising early results suggest the Yamane technique is an effective and safe option in the setting of compromised capsular support. Further investigations of long term outcomes and comparative studies to alternatives as required. When this technique should be utilised in preference to an ACIOL and whether it can only be performed safely in vitrectomised eyes requires further investigation.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.