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KMID : 0360220230640111041
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Journal of the Korean Ophthalmological Society
2023 Volume.64 No. 11 p.1041 ~ p.1047
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Closed-loop Scleral Fixation with 4-eyelet Intraocular Lens Implantation for Aphakia: Clinical Outcomes
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Kim Jung-Dong
Lee Jun-Won
Yang Jong-Yun
Choi Eun-Young
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Abstract
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Purpose: We present a modified, closed-loop scleral fixation technique. We inserted a 4-eyelet intraocular lens (IOL) into the anterior chamber prior to fixation. We investigated the clinical results.
Methods: We retrospectively reviewed 39 eyes (39 patients) that underwent modified four-point scleral fixation of an inserted lens in our center from May 2019 to June 2022. The surgical procedure features conjunctival peritomy, 4-eyelet IOL insertion, eyeball penetration using a 9-0 polypropylene needle, eyelet placement using an ab externo technique to form a continuous loop, centering of the optic, and tying of a knot. We compared preoperative and 6-month postoperative changes in best-corrected visual acuity (BCVA), intraocular pressure, and refraction errors, and described postoperative complications.
Results: The mean patient age was 62 years. The indications for surgery included complicated cataracts (20.5%), aphakia (20.5%), staged surgery for complicated cataract (12.8%), non-traumatic IOL dislocation (30.8%), traumatic IOL dislocation (12.8%), and crystalline lens dislocation (5.1%). The postoperative BCVA (0.40 logarithm of the minimum angle of resolution [logMAR]) was significantly better than the preoperative BCVA (0.69 logMAR) (p = 0.018). The postoperative spherical equivalent and the target diopter measurement were in high agreement (p = 0.002, intraclass correlation coefficient = 0.616). All of ocular hypertension (7.7%), hypotony (5.1%), bullous keratopathy (5.1%), and macular edema (5.1%) were noted, but 78% of the conditions improved with short-term medication. There was no re-dislocation of a fixated IOL.
Conclusions: Our surgical technique simply and rapidly treats aphakia. Optic repositioning was easy, the IOL stability high, and the risk of complications during IOL fixation low.
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KEYWORD
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Aphakia, Closed-loop scleral fixation, Intraocular lens, Lens dislocation
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