Abstract
Background
To report the indications, visual outcomes, and intra-operative and post-operative complications of iris-sutured posterior chamber intraocular lens (IOL) in eyes with inadequate capsular support and complex ocular history.
Methods
A chart review and data analysis of eyes that underwent iris fixation of posterior chamber (PC) IOL for correction of aphakia, dislocated and subluxed IOLs, ectopia lentis, and IOL exchange. Data included clinical risk factors, associated eye conditions, previous surgeries, and concomitant procedures. The pre-operative and post-operative vision, manifest refraction, endothelial cell density, intraocular pressure (IOP), as well as intra-operative and post-operative complications were also recorded.
Results
One hundred and seventeen eyes from 114 patients were examined with a mean follow-up of 22.4 months. The most common identifiable predisposing risk factor was high myopia in 23 eyes. A significant improvement in uncorrected and best corrected visual acuity compared with baseline was observed. The most common post-operative complications included recurrent IOL subluxation in 16 (13.7%) eyes, IOP spike in 7 (5.9%) eyes, cystoid macular oedema in 5 (4.3%) eyes, and epiretinal membrane formation in 4 (3.4%) eyes. There was one (0.85%) case of sterile endophthalmitis.
Conclusions
Iris suture fixation of PC IOLs is a good treatment option for eyes with inadequate capsular support and complex ocular history.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Price FW Jr, Whitson WE. Visual results of suture-fixated posterior chamber lenses during penetrating keratoplasty. Ophthalmology. 1989;96:123–40. S0161-6420(89)32760-6.
Stark WJ, Worthen DM, Holladay JT, Bath PE, Jacobs ME, Murray GC, et al. The FDA report on intraocular lenses. Aust J Ophthalmol. 1984;12:61–9.
Stark WJ Jr, Maumenee AE, Datiles M, Fagadau W, Baker CC, Worthen D, et al. Intraocular lenses: complications and visual results. Trans Am Ophthalmol Soc. 1983;81:280–309.
Kratz RP, Mazzocco TR, Davidson B, Colvard DM. The shearing intraocular lens: a report of 1000 cases. J Am Intraocul Implant Soc. 1981;7:55–7.
Li X, Ni S, Li S, Zheng Q, Wu J, Liang G, et al. Comparison of three intraocular lens implantation procedures for aphakic eyes with insufficient capsular support: a network meta-analysis. Am J Ophthalmol. 2018;192:10–19. S0002-9394(18)30204-6.
Lyle WA, Jin JC. Secondary intraocular lens implantation: anterior chamber vs posterior chamber lenses. Ophthalmic Surg 1993;24:375–81.
Hennig A, Evans JR, Pradhan D, Johnson GJ, Pokhrel RP, Gregson RM, et al. Randomised controlled trial of anterior-chamber intraocular lenses. Lancet 1997;349:1129–33. S0140673696110436.
Khan MA, Gupta OP, Smith RG, Ayres BD, Raber IM, Bailey RS, et al. Scleral fixation of intraocular lenses using gore-tex suture: clinical outcomes and safety profile. Br J Ophthalmol. 2016;100:638–43. https://doi.org/10.1136/bjophthalmol-2015-306839.
Hannush SB. Sutured posterior chamber intraocular lenses: indications and procedure. Curr Opin Ophthalmol. 2000;11:233–40.
Agarwal A, Kumar DA, Jacob S, Baid C, Agarwal A, Srinivasan S. Fibrin glue-assisted sutureless posterior chamber intraocular lens implantation in eyes with deficient posterior capsules. J Cataract Refract Surg. 2008;34:1433–8. https://doi.org/10.1016/j.jcrs.2008.04.040.
Yamane S, Sato S, Maruyama-Inoue M, Kadonosono K. Flanged intrascleral intraocular lens fixation with double-needle technique. Ophthalmology 2017;124:1136–42. S0161-6420(16)32178-9.
Michaeli A, Soiberman U, Loewenstein A. Outcome of iris fixation of subluxated intraocular lenses. Graefes Arch Clin Exp Ophthalmol. 2012;250:1327–32. https://doi.org/10.1007/s00417-012-2057-x.
Chu MW, Font RL, Koch DD. Visual results and complications following posterior iris-fixated posterior chamber lenses at penetrating keratoplasty. Ophthalmic Surg 1992;23:608–13.
Por YM, Lavin MJ. Techniques of intraocular lens suspension in the absence of capsular/zonular support. Surv Ophthalmol 2005;50:429–62. S0039-6257(05)00084-6.
Soiberman U, Pan Q, Daoud Y, Murakami P, Stark WJ. Iris suture fixation of subluxated intraocular lenses. Am J Ophthalmol. 2015;159:353–9. https://doi.org/10.1016/j.ajo.2014.11.009.
Stutzman RD, Stark WJ. Surgical technique for suture fixation of an acrylic intraocular lens in the absence of capsule support. J Cataract Refract Surg. 2003;29:1658–62. S0886335003000543
Holladay JT. Proper method for calculating average visual acuity. J Refract Surg. 1997;13:388–91.
Schulze-Bonsel K, Feltgen N, Burau H, Hansen L, Bach M. Visual acuities “hand motion” and “counting fingers” can be quantified with the freiburg visual acuity test. Investig Ophthalmol Vis Sci. 2006;47:1236–40. doi: 47/3/1236
Pueringer SL, Hodge DO, Erie JC. Risk of late intraocular lens dislocation after cataract surgery, 1980-2009: a population-based study. Am J Ophthalmol. 2011;152:618–23. https://doi.org/10.1016/j.ajo.2011.03.009.
Ascaso FJ, Huerva V, Grzybowski A. Epidemiology, etiology, and prevention of late IOL-capsular bag complex dislocation: review of the literature. J Ophthalmol. 2015;2015:805706. https://doi.org/10.1155/2015/805706.
Krepste L, Kuzmiene L, Miliauskas A, Januleviciene I. Possible predisposing factors for late intraocular lens dislocation after routine cataract surgery. Medicina. 2013;49:229–34. doi: 1305-05e.
Hayashi K, Hirata A, Hayashi H. Possible predisposing factors for in-the-bag and out-of-the-bag intraocular lens dislocation and outcomes of intraocular lens exchange surgery. Ophthalmology. 2007;114:969–75. S0161-6420(06)01317-0.
Ostern AE, Sandvik GF, Drolsum L. Late in-the-bag intraocular lens dislocation in eyes with pseudoexfoliation syndrome. Acta Ophthalmol. 2014;92:184–91. https://doi.org/10.1111/aos.12024.
Jones JJ, Jones YJ, Jin GJ. Indications and outcomes of intraocular lens exchange during a recent 5-year period. Am J Ophthalmol. 2014;157:15–162.e1. https://doi.org/10.1016/j.ajo.2013.08.019.
Jakobsson G, Zetterberg M, Lundstrom M, Stenevi U, Grenmark R, Sundelin K. Late dislocation of in-the-bag and out-of-the bag intraocular lenses: ocular and surgical characteristics and time to lens repositioning. J Cataract Refract Surg. 2010;36:1637–44. https://doi.org/10.1016/j.jcrs.2010.04.042.
Vote BJ, Tranos P, Bunce C, Charteris DG, Da Cruz L. Long-term outcome of combined pars plana vitrectomy and scleral fixated sutured posterior chamber intraocular lens implantation. Am J Ophthalmol. 2006;141:308–12. S0002-9394(05)01020-2.
Kumar DA, Agarwal A, Prakash G, Jacob S, Saravanan Y, Agarwal A. Glued posterior chamber IOL in eyes with deficient capsular support: a retrospective analysis of 1-year post-operative outcomes. Eye. 2010;24:1143–8. https://doi.org/10.1038/eye.2010.10.
Schein OD, Kenyon KR, Steinert RF, Verdier DD, Waring GO 3rd, Stamler JF, et al. A randomized trial of intraocular lens fixation techniques with penetrating keratoplasty. Ophthalmology. 1993;100:1437–43. S0161-6420(93)31458-2.
Condon GP, Masket S, Kranemann C, Crandall AS, Ahmed II. Small-incision iris fixation of foldable intraocular lenses in the absence of capsule support. Ophthalmology.2007;114:1311–8.S0161-6420(07)00438-1.
Kim KH, Kim WS. Comparison of clinical outcomes of iris fixation and scleral fixation as treatment for intraocular lens dislocation. Am J Ophthalmol. 2015;160:46–469.e1. https://doi.org/10.1016/j.ajo.2015.06.010.
Vounotrypidis E, Schuster I, Mackert MJ, Kook D, Priglinger S, Wolf A. Secondary intraocular lens implantation: a large retrospective analysis. Graefes Arch Clin Exp Ophthalmol. 2019;257:125–34. https://doi.org/10.1007/s00417-018-4178-3.
Banker TP, Reilly GS, Jalaj S, Weichel ED. Epiretinal membrane and cystoid macular edema after retinal detachment repair with small-gauge pars plana vitrectomy. Eur J Ophthalmol. 2015;25:565–70. https://doi.org/10.5301/ejo.5000609.
Wetzig PC, Thatcher DB, Christiansen JM. The intracapsular versus the extracapsular cataract technique in relationship to retinal problems. Trans Am Ophthalmol Soc. 1979;77:339–47.
Moisseiev E, Kinori M, Glovinsky Y, Loewenstein A, Moisseiev J, Barak A. Retained lens fragments: nucleus fragments are associated with worse prognosis than cortex or epinucleus fragments. Eur J Ophthalmol. 2011;21:741–7. https://doi.org/10.5301/EJO.2011.6483.
Funding
Unrestricted research grants from the Michael O’Bannon foundation and the Turner family.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Dzhaber, D., Mustafa, O.M., Tian, J. et al. Outcomes and complications of iris-fixated intraocular lenses in cases with inadequate capsular support and complex ophthalmic history. Eye 34, 1875–1882 (2020). https://doi.org/10.1038/s41433-019-0759-6
Received:
Revised:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41433-019-0759-6
This article is cited by
-
Preferred surgical techniques for secondary intraocular lens implantation in adults with aphakia
International Ophthalmology (2023)
