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Anterior chamber, scleral-fixated IOLs yield similar long-term outcomes
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Primary anterior chamber IOL implantation and secondary scleral-fixated IOL implantation after complicated cataract surgery in eyes with inadequate capsular support yielded comparable long-term visual outcomes and complication rates, according to a study.
The retrospective study included 89 eyes implanted with a primary anterior chamber IOL (ACIOL) and 74 eyes implanted with a secondary scleral-fixated IOL. Mean follow-up was 64.1 months.
Eyes in the ACIOL group received a single-piece, four-point fixation, open-loop polymethyl methacrylate (PMMA) flexible lens, either the Pharmacia 351C (Pharmacia International) or the S112UV (Bausch + Lomb). Eyes in the secondary scleral-fixated IOL group received a single-piece PMMA IOL with eyelets (MCZ70BD, Alcon).
Mean postoperative BCVA was 0.32 in the primary ACIOL group and 0.34 in the secondary scleral-fixated IOL group at 1 year. The between-group difference was statistically insignificant.
Mean latest BCVA was 0.68 in the primary ACIOL group and 0.61 in the secondary scleral-fixated IOL group. The difference was insignificant.
Both groups had a similar proportion of eyes with BCVA of 20/40 or better at 1 year and final follow-up.
Early postoperative complications within 1 month occurred in 62 of 89 eyes (69.7%) in the primary ACIOL group and in 29 of 74 eyes in the secondary IOL group (39.7%). The between-group difference was statistically significant (P < .001). However, both groups had the same rate of late postoperative complications after 1 month.
“Primary ACIOL implantation allows immediate aphakic correction without prolonging the complicated operation extensively. … On the other hand, secondary scleral-fixated IOL implantation allows better surgical planning in a more controlled situation,” the study authors wrote.
Disclosure: The study authors report no relevant financial disclosures.
Perspective
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Amar Agarwal, MS, FRCS, FRCOphth
The study very well demonstrates the results of anterior chamber IOL implantation and secondary scleral-fixated sutured IOLs, and highlights the fact that the postoperative visual outcome was the same in both the groups in this study. Although ACIOLs are easy to place in the eye and the procedure can be done in the same setting, still it is not an ideal place to put an IOL. Scleral fixation of an IOL should be ideally done in the same sitting, and in referred cases for scleral fixation, the duration between the initial surgery and the secondary procedure plays a very important role. Following cataract surgery, the cases that were referred for scleral fixation at a later stage deserve a mention as to whether adequate vitrectomy with removal of retained nuclear fragments was performed at the initial stage; initial management helps cut down traction on the vitreous strands and may affect the final outcome of the surgery.
Long-term analysis of the results adds a lot of value to the current study, although in our setup we prefer to do glued intrascleral fixation of an IOL.
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