Comparison of Clinical Outcome of Iris Fixation With Scleral Fixation as Treatment of IOL Dislocation
Purpose
To compare visual outcomes observed postoperatively in patients with subluxated IOL treated with iris fixation and scleral fixation of IOL
Methods
This retrospective interventional comparative case series was performed using thirty-five eyes of 34 patients who underwent iris fixation of IOL and 44 eyes of 44 patients who were treated with scleral fixation of IOL.Medical records of 78 consecutive patients who underwent surgical repositioning of dislocated IOL using suturing to the sclera or iris from 2010 to 2013 were reviewed.Enrolled patients were divided into two groups by the surgical method performed to correct dislocation. Thirty-five eyes of 34 patients were treated with iris fixation of IOL using Modified McCannel method (IF group) and 44 eyes of 44 patients underwent scleral fixation of IOL (SF group). The main outcome was postoperative corrected distant visual acuity (CDVA), surgically induced corneal astigmatism, operation time, and complications including recurrence of IOL subluxation.
Results
Postoperative CDVA(LogMAR) improved significantly from 0.55 preoperatively to 0.22 in IF group, and from 0.52 to 0.24 in SF group (p<0.001, p=0.001, respectively; Wilcoxon Signed Rank test). Corneal astigmatism was not induced significantly in the both groups (-0.03 Diopter(D) in IF group and 0.02 D in SF group, p>0.05 in both groups; Mann-Whitney U test). Mean operation time was significantly shorter in IF group as 38.9 min compared to 49.3 min of SF group (p=0.002, Mann-Whitney U test). Recurrence of IOL subluxation occurred 5 eyes (14.3%) in IF group and 3 eyes (7.5%) in SF group, however the between-group difference was insignificant (p>0.05, Fischer’s exact test).
Conclusion
Both iris and scleral fixation techniques for the reposition of dislocated IOL showed comparable results in terms of efficacy. Iris fixation had advantage of less operation time, however disadvantages such as induced astigmatism, immediate postoperative inflammation, earlier recurrence and less stable refraction should be concerned for this technique.