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Two methods of IOL implantation yield similar vision, low complication rates in long term
However, patients with a primary anterior chamber IOL had significantly more early postoperative complications than patients with a secondary scleral-fixated IOL.
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Primary anterior chamber IOL implantation and secondary scleral-fixated IOL implantation in eyes with inadequate capsular support resulted in comparable long-term visual outcomes and complication rates, according to a study.
Primary anterior chamber IOL (ACIOL) implantation is recommended when the expertise for scleral-fixated IOL (SFIOL) insertion is not available or a patient cannot afford the procedure. On the other hand, secondary scleral-fixated IOL implantation affords better surgical planning in a more controlled setting.
“ACIOL and SFIOL have similar long-term safety profiles and visual outcomes,” corresponding author Emmy Y.M. Li, FRCS, told Ocular Surgery News.
The study was published in the American Journal of Ophthalmology.
Patients and methods
The retrospective study included 89 eyes implanted with a primary anterior chamber IOL and 74 eyes implanted with a secondary scleral-fixated IOL.
Mean patient age was 78.8 years in the anterior chamber IOL group and 73.1 years in the scleral-fixated IOL group.
“There was a significant difference in age between the two groups in this study,” Li said. “Patients who had an ACIOL implanted were older. The rationale behind this practice was the presumption that complications of ACIOL develop later, presumably well beyond the life expectancy of the patients. Despite the discrepancy, age by itself did not significantly affect the final visual outcome according to our multivariate analysis.”
Eyes in the anterior chamber IOL group received a single-piece, four-point fixation, PMMA flexible lens, either the Pharmacia 351C (Pharmacia International) or the S112UV (Bausch + Lomb).
Eyes in the scleral-fixated IOL group received a single-piece PMMA IOL with eyelets (CZ70BD, Alcon).
The primary outcome measures were postoperative logMAR best corrected visual acuity and postoperative complications. Mean follow-up was 64.1 months.
Visual acuity and complications
Mean postoperative BCVA was 0.32 in the anterior chamber IOL group and 0.34 in the scleral-fixated IOL group at 1 year. The between-group difference was statistically insignificant.
Mean latest BCVA was 0.68 in the anterior chamber IOL group and 0.61 in the 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.
Absolute spherical equivalent was 1.38 D in the anterior chamber IOL group and 1.63 D in the scleral-fixated IOL group; the difference was insignificant.
“Also, there was no intergroup difference in astigmatism,” Li said.
Early postoperative complications occurred in 62 of 89 eyes (69.7%) in the anterior chamber IOL group and in 29 of 74 eyes in the scleral-fixated IOL group (39.2%) at 1 month. The between-group difference was statistically significant (P < .001).
Late complications occurred in 23 of 89 eyes (25.8%) in the anterior chamber IOL group and 28 of 74 (37.8%) eyes in the scleral-fixated IOL group; the between-group difference was statistically insignificant.
“We observed that eyes with late complications had significantly worse BCVA after primary implantation of an ACIOL compared to the secondary implantation of a scleral-fixated IOL. This may be explained by the different patterns of late complications encountered in each group,” Li said. “Although not statistically significant, there were more eyes with bullous keratopathy, cystoid macular edema and retinal detachment in the primary ACIOL group. On the other hand, more eyes with secondary scleral-fixated IOLs suffered from high intraocular pressure, persistent anterior uveitis and IOL tilting, which affected vision to a lesser extent.” – by Matt Hasson
Reference:
Chan TC, et al. Am J Ophthalmol. 2014;doi:10.1016/j.ajo.2014.10.016.For more information:
Emmy Y.M. Li, FRCS, can be reached at Hong Kong Eye Hospital, 147K Argyle St., Kowloon, Hong Kong SAR, China; email: dr.emmyli@gmail.com.Disclosure: Li reports no relevant financial disclosures.