Favorable ocular prognoses were seen following 3 intraocular lens (IOL) repositioning techniques: 2-point sutured transscleral fixation (2PSTF), 1-point sutured transscleral fixation (1PSTF), and sutureless intrascleral IOL fixation (SIF), according to findings published in BMC Ophthalmology. Patients who underwent these IOL repositioning techniques all had similar outcomes in terms of visual prognosis, endothelial cell density (ECD) damage, and intraocular pressure (IOP).
Researchers conducted a retrospective study to compare the outcomes of sutured transscleral fixation and sutureless intrascleral fixation for the treatment of a dislocated IOLs. The study included 35 eyes of 35 patients who required IOL repositioning surgery due to IOL dislocation.
Patients underwent 1 of the 3 IOL repositioning procedures (2PSTF, n=16; 1PSTF, n=8; SIF, n=11). The researchers recorded and analyzed postoperative outcomes at 12 months or more following repositioning surgery. Ocular blunt trauma was the primary cause of dislocation (19/35, 54.3%).
The study found that, after IOL repositioning, the mean corrected distance visual acuity (CDVA) improved significantly (P =.022). The mean postoperative change in endothelial cell density (ECD) was -4.5%. Among the 3 groups, there were no significant differences in the changes in CDVA or ECD with different repositioning techniques (both P >.1).
The mean vertical tilt of the IOLs in all participants was significantly greater compared with the horizontal value (P =.001). Compared with the SIF group, the vertical tilt was greater in the 2PSTF group (P =.048). In the 1PSTF group, the mean decentration values in the horizontal and vertical directions were greater than with the other 2 IOL repositioning techniques (all P <.01).
The researchers explain that suture-related complications are the main concern in IOL repositioning, although the procedure provides advantages including less corneal endothelial cell loss and fewer peripheral anterior synechiae.
“To reduce the tilt of the IOL, a technique involving fixation at 3 or more points should be considered,” the researchers note.
Zonular weakness and an inadequate capsule are considered the main reasons for intraocular lens dislocation, according to the study.
The study also highlighted that its sample size and followup was limited, which may have confounded study results. However, in terms of visual prognosis, ECD damage, and IOP, the surgical efficacy of all 3 IOL repositioning techniques appeared to be similar.
Zhang Y, Zong Y, Zhu X, et al. Comparison of sutureless intrascleral fixation and sutured scleral fixation for the treatment
of dislocated intraocular lenses. BMC Ophthalmol. Published online June 13, 2023. doi:10.1086/s12886-023-03020-1