Trans-scleral Fixation of Posterior Chamber Intra-ocular Lens Combined with Vitreoretinal Surgery
Purpose: To report the outcomes of trans-scleral fixation of posterior chamber intraocular lens (PCIOL) combined with complete vitrectomy and prophylactic band placement.
Methods: Hospital records of 18 patients who underwent the procedure were reviewed. Indications for vitreoretinal surgery included previous penetrating ocular trauma, complicated cataract surgery and vitreous incarceration, and chronic cystoid macular edema. All patients had iris and angle damage with inadequate lens capsular support. Age, sex, surgical technique, follow up duration and pre- and postoperative best corrected visual acuity (BCVA) were evaluated.
Results: Overall 18 eyes of 18 patients (14 men and 4 women) with mean age of 34.8±23 (range 5-76) years were operated. Mean follow up duration was 36±32.4 (range 6-96) months. Of the 18 operated eyes 7 were aphakic, 6 had complete IOL dislocation into the vitreous cavity, 4 had subluxated cataractous lens and one had a subluxated IOL. The number of eyes with BCVA ≥ 20/40 increased from 3 (16.7%) preoperatively to 9 (50%) postoperatively (P<0.01). Postoperative complications were encountered in 9 eyes and included uveitis, vitreous hemorrhage, repeat IOL dislocation and retinal detachment.
Conclusion: In the absence of adequate capsular support, trans-scleral fixation of a PCIOL combined with vitreoretinal surgery seems to be effective for visual rehabilitation in selected patients with complicated cataracts or previous cataract surgery. Application of this technique in children deserves caution. Larger studies and a randomized clinical trial with long-term follow up are required to confirm these results.
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