Safety and Efficacy of Current Sclera Fixation Methods for Intraocular Lenses and Literature Overview

Muth, Daniel Rudolf; Wolf, Armin; Kreutzer, Thomas; Shajari, Mehdi; Vounotrypidis, Efstathios; Priglinger, Siegfried und Mayer, Wolfgang J. (2021): Safety and Efficacy of Current Sclera Fixation Methods for Intraocular Lenses and Literature Overview. In: Klinische Monatsblätter für Augenheilkunde, Bd. 238, Nr. 8: S. 868-874

Abstract

Background Evaluation of the three currently most common techniques for intraocular lens (IOL) sclera fixation: (1) Prolene suture with Hoffman sclera pocket (2) four-point GoreTex suture technique (3) sutureless flanged intrascleral IOL fixation with double-needle (Yamane) technique. Material and Methods Retrospective, clinical case series (chart review) at the Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich, Germany. Enrolled in the study were 51 patients with 55 eyes. Best-corrected visual acuity (BCVA);manifest refraction (OR);corneal tomography (central corneal thickness, CCT);biometry;central macular thickness (CMT) by optical coherence tomography (OCT);intraocular pressure (IOP);and IOL type and IOL power were recorded and compared prior to and 3-12 months post IOL sclera fixation surgery. Pre- and postsurgery difference analysis was performed by Wilcoxon rank sum testing (z). Results Intrascleral fixation by GoreTex suture was performed in 14 (25.5%) eyes, by Prolene suture in 19 (34.5%,) and by Yamane technique in 22 (40.0%) eyes. Within the 3-12 months follow-up post scleral fixation, a total of 2 (14.3%) eyes from the GoreTex, 3 (15.8%) from the Prolene and 1 (4.5%) eye from the Yamane group required refixation. Preand post-surgery analysis revealed a statistically significant difference in the total patient population BCVA (exact Wilcoxon test: z = - 3.202;p = 0.001;n = 55) and the Yamane subgroup (exact Wilcoxon test: z = - 2.068;p = 0.001;n = 22). The GoreTex ( n = 14) and Prolene (n = 19) subgroups revealed no statistically significant differences versus pre-operative baseline. Across groups, there was no statistically significant difference in IOP, CMT, and CCT. No retinal complications were observed, neither intraoperatively nor during follow-up. Conclusion The volume of IOL revision surgery is increasing. Often, the only option left for visual rehabilitation is scleral IOL fixation. All three scleral fixation techniques studied demonstrated a good safety profile with no statistically significant impact on IOP, CMT, CCT, but with a notable revision rate. Visual rehabilitation to preoperative baseline levels (GoreTex [n = 14] and Prolene [n = 19]) and a statistically significant increase in visual acuity (total cohort [n = 55] and Yamane [n = 22]) seems possible. Unlike iris fixation, scleral fixation is surgically more complex and the surgeon must master a steeper learning curve.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0023-2165
• Sprache: Englisch