Comparison of outcomes of scleral fixation with and without pars plana vitrectomy for the treatment of dislocated intraocular lens

• Published in: Graefe's archive for clinical and experimental ophthalmology Vol. 255; no. 12; pp. 2503 - 2509
• Main Authors: Choi, Seung Yong, Hwang, You Sook, Kim, Mirinae, Choi, Soon Il, Park, Young-Hoon
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2017; Springer Nature B.V
• Subjects: Acuity; Artificial Lens Implant Migration - diagnosis; Artificial Lens Implant Migration - physiopathology; Artificial Lens Implant Migration - surgery; Astigmatism; Dislocation; Electronic medical records; Female; Follow-Up Studies; Humans; Lenses, Intraocular; Male; Medicine; Medicine & Public Health; Middle Aged; Ophthalmology; Refractive Surgery; Reoperation; Retrospective Studies; Sclera - surgery; Statistical analysis; Surgical outcomes; Suture Techniques - instrumentation; Time Factors; Visual Acuity; Vitrectomy; Artificial lens implant dislocation; Vitrectomy; Intraocular lens implantation; Astigmatism
• ISSN: 0721-832X; 1435-702X
• DOI: 10.1007/s00417-017-3802-y

Purpose To investigate the surgical outcomes of scleral fixation with either pars plana vitrectomy (ppV) or anterior vitrectomy (AV) for the treatment of dislocated intraocular lens (IOL). Methods By retrospective review of electronic medical records, patients with in-the-bag spontaneous IOL dislocation who underwent IOL exchange with scleral fixation were included and grouped according to the vitrectomy method: ppV (group 1) and AV (group 2). Post-operative surgical outcomes including visual acuity (log MAR), spherical equivalent, and surgically induced astigmatism (SIA) and complications were investigated and analyzed. Results After 6 months, post-operative measurements showed an average visual acuity of 0.16 ± 0.20, spherical equivalent of −1.48 ± 1.53D (diopters), and refractive shift of −0.19 ± 0.44D in group 1 ( n  = 19). There was no statistically significant difference between the measurements of group 1 and group 2 ( n  = 20) (0.10 ± 0.12, −2.00 ± 1.71D, −0.39 ± 0.57D, respectively) ( p  = 0.51, p  = 0.29, p  = 0.16, respectively). When analyzed by the algebraic and vector methods, group 1 did show a higher magnitude of surgically induced astigmatisms (1.61 ± 1.50D, 2.10 ± 1.03D, respectively) than did group 2 (0.49 ± 1.02D, 1.31 ± 0.83D respectively) (both p’s = 0.01). There was no significant difference in the incidence of complications except for vitreoretinal complications, which were higher in group 2 (25%), compared with group 1 (0%) ( p  = 0.047). Conclusions Both ppV and AV are appropriate options in patients who need IOL exchange with scleral fixation based on visual outcomes, refractive shifts, and complication rates. In terms of managing astigmatism, the AV procedure may be the better option.