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¹Numune Eğitim ve Araştırma Hastanesi 1.Göz Kliniği Asistanı, Ankara
²Numune Eğitim ve Araştırma Hastanesi 1.Göz Kliniği Uzmanı, Ankara
³Numune Eğitim ve Araştırma Hastanesi 1.Göz Kliniği Şefi, Ankara Purpose: To evaluate the safety and visual outcome of primary or secondary transscleral fixation (TF) of posterior chamber intraocular lenses (PC-IOLs) in eyes with inadequate capsular support as a result of various etiologies.
Materials and Methods: The records of 103 eyes of 98 patients (63 male, 35 female; mean age 49.4±22.0 years) who have undergone TF of PC-IOL implantation between January 1997 and January 2005 have been retrospectively reviewed. Eyes were divided into 4 groups according to their clinical and surgical properties. There were 17 eyes that underwent primary TF of PC-IOL implantation for traumatic cataract extraction in Group 1, 32 eyes that underwent primary TF of PC-IOL implantation for (sub)luxated lens or IOL exchange in Group 2, 16 eyes that underwent secondary TF of PC-IOL implantation for complicated surgery in traumatic cataract in Group 3, and 38 eyes that underwent secondary TF of PC-IOL implantation for previously complicated cataract surgery with vitreous loss in Group 4.
Results: Mean follow-up time was 11.6±11.5 (3-57) months. There was a statistically significant difference among groups in terms of preoperative best corrected visual acuity (BCVA) (p<0.001). Preoperative BCVA in Group 1 and Group 2 were statistically significantly lower than those in Group 3 and Group 4. There was no statistically significant difference among groups in terms of postoperative BCVA (p>0.05). As the difference between preoperative and postoperative BCVA in each group was investigated, postoperative BCVA in Group 1 and Group 2 was found to be significantly increased as compared to preoperative values (p=0.02 and p<0.001, respectively), while there was no significant difference for those of Group 3 and Group 4 (p>0.05). Of 103 eyes, final BCVA was found to be <0.1 in 11.6% of eyes, ≥0.1 in 88.4% of eyes, and ≥0.5 in 40.8% of eyes. BCVA was found to be decreased an amount of ≥1 Snellen line postoperatively in 16.5% of all eyes. Peripheral anterior synechia (28%), pupillary ectopia (25%), pigment precipitation at iridocorneal angle (20%), macular edema (17%), and suture erosion (13%) were the most common complications.
Conclusion: TF of PC-IOL implantation is a safe procedure to provide sufficent visual results in eyes with inadequate capsular support. Expectancy of visual outcome should be outlined with respect to etiology. The goals of either achieving an increased visual outcome or preserving preoperative BCVA could be succeeded, if TF of PC-IOL implantation is performed as a primary or a secondary procedure, respectively. Keywords : Transscleral fixation, cataract surgery, intraocular lens