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Sutured glued scleral IOL implantations show similar outcomes at 6 months
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Suture-assisted and fibrin glue-assisted scleral fixated IOL implantation proved similarly effective in the long term, a study found.
“Although visual outcomes were similar at the end of 6 months in eyes that underwent suture- and glue-assisted scleral fixated IOL implantation, fibrin glue was associated with fewer complications,” the study authors said.
The prospective, nonrandomized, interventional study examined visual outcomes and complications after suture-assisted and fibrin glue-assisted scleral-fixated IOL implantation in patients with insufficient capsular support.
Of the 50 patients included in the study, 25 underwent suture-assisted IOL implantation and 25 underwent fibrin glue-assisted implantation. Twenty-nine of 50 patients underwent scleral-fixated IOL implantation because of posterior capsule rupture occurring during primary cataract surgery.
Patients in both groups had similar demographic characteristics, indications and preoperative corrected distance visual acuity.
No intraoperative complications were associated with either method of IOL fixation.
At 6-month follow-up, 88% of patients in the suture-assisted fixation group and 84% of patients in the glue-assisted fixation group had corrected distance visual acuity of 20/40 or better.
Postop inflammation was identified in 48% of eyes in the suture group and 16% of eyes in the fibrin glue group. Glaucoma was seen in 40% of eyes in the suture group and 16% of eyes in the glue group.
Complications occurred in 56% of eyes in the suture group and 28% of eyes in the fibrin glue group; the between-group difference was statistically significant (P = .045).
Perspective
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John A. Hovanesian, MD, FACS
Fibrin glue assisted scleral fixation of posterior chamber IOLs, as originally described by Amar Agarwal, is a technique of growing popularity because of the simplicity of the concept and the belief that fixation without suture may allow fewer future complications. This 6-month study of 25 glued subjects suggests that early outcomes are at least similar (and perhaps safer) to those of sutured posterior chamber IOLs. Although the two groups are not matched for preoperative morbidity, and it does not appear that patients were randomized, it is encouraging to see that these glued IOLs fare so well. Dr. Agarwal’s own longer term data also corroborate the findings of this new study.
Every cataract surgeon needs to be familiar with at least one (and preferably more than one) technique for fixing a posterior chamber IOL in the absence of capsular support, and I suspect that fibrin-assisted scleral fixation will increasingly become a preferred technique for these challenging cases.
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J Refract Surg. 2012;28(4):249-252.
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