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

  • Seung Yong Choi
  • You Sook Hwang
  • Mirinae Kim
  • Soon Il Choi
  • Young-Hoon Park
Refractive Surgery

Abstract

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.

Keywords

Artificial lens implant dislocation Intraocular lens implantation Vitrectomy Astigmatism 

References

  1. 1.
    Gimbel HV, Condon GP, Kohnen T, Olson RJ, Halkiadakis I (2005) Late in-the-bag intraocular lens dislocation: incidence, prevention, and management. J Cataract Refract Surg 31:2193–2204. https://doi.org/10.1016/j.jcrs.2005.06.053 CrossRefPubMedGoogle Scholar
  2. 2.
    Gross JG, Kokame GT, Weinberg DV (2004) In-the-bag intraocular lens dislocation. Am J Ophthalmol 137:630–635. https://doi.org/10.1016/j.ajo.2003.10.037 PubMedGoogle Scholar
  3. 3.
    Pueringer SL, Hodge DO, Erie JC (2011) Risk of late intraocular lens dislocation after cataract surgery, 1980-2009: a population-based study. Am J Ophthalmol 152:618–623. https://doi.org/10.1016/j.ajo.2011.03.009 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Davis D, Brubaker J, Espandar L, Stringham J, Crandall A, Werner L, Mamalis N (2009) Late in-the-bag spontaneous intraocular lens dislocation: evaluation of 86 consecutive cases. Ophthalmology 116:664–670. https://doi.org/10.1016/j.ophtha.2008.11.018 CrossRefPubMedGoogle Scholar
  5. 5.
    Fernandez-Buenaga R, Alio JL, Perez-Ardoy AL, Larrosa-Quesada A, Pinilla-Cortes L, Barraquer R, Alio JL 2nd, Munoz-Negrete FJ (2013) Late in-the-bag intraocular lens dislocation requiring explantation: risk factors and outcomes. Eye (Lond) 27:795–801; quiz 802. https://doi.org/10.1038/eye.2013.95 CrossRefGoogle Scholar
  6. 6.
    Johnston RL, Charteris DG, Horgan SE, Cooling RJ (2000) Combined pars plana vitrectomy and sutured posterior chamber implant. Arch Ophthalmol 118:905–910PubMedGoogle Scholar
  7. 7.
    Nabors G, Varley MP, Charles S (1990) Ciliary sulcus suturing of a posterior chamber intraocular lens. Ophthalmic Surg 21:263–265PubMedGoogle Scholar
  8. 8.
    Tsunoda K, Migita M, Nakashizuka T, Kohzuka T (1996) Treatment of anterior vitreous before suturing and intraocular lens to the ciliary sulcus. J Cataract Refract Surg 22:222–226CrossRefPubMedGoogle Scholar
  9. 9.
    Hannush SB (2000) Sutured posterior chamber intraocular lenses: indications and procedure. Curr Opin Ophthalmol 11:233–240CrossRefPubMedGoogle Scholar
  10. 10.
    Vote BJ, Tranos P, Bunce C, Charteris DG, Da Cruz L (2006) Long-term outcome of combined pars plana vitrectomy and scleral fixated sutured posterior chamber intraocular lens implantation. Am J Ophthalmol 141:308–312. https://doi.org/10.1016/j.ajo.2005.09.012 CrossRefPubMedGoogle Scholar
  11. 11.
    Bading G, Hillenkamp J, Sachs HG, Gabel VP, Framme C (2007) Long-term safety and functional outcome of combined pars plana vitrectomy and scleral-fixated sutured posterior chamber lens implantation. Am J Ophthalmol 144:371–377. https://doi.org/10.1016/j.ajo.2007.05.014 CrossRefPubMedGoogle Scholar
  12. 12.
    Kim SS, Smiddy WE, Feuer W, Shi W (2008) Management of dislocated intraocular lenses. Ophthalmology 115:1699–1704. https://doi.org/10.1016/j.ophtha.2008.04.016 CrossRefPubMedGoogle Scholar
  13. 13.
    Kim SW, Kim MJ, Yang KS, Sohn JH, Huh K (2009) Risk factors for pseudophakic retinal detachment after intraocular lens scleral fixation with or without pars plana vitrectomy. Retina 29:1479–1485. https://doi.org/10.1097/IAE.0b013e3181aade61 CrossRefPubMedGoogle Scholar
  14. 14.
    Cho BJ, Yu HG (2014) Surgical outcomes according to vitreous management after scleral fixation of posterior chamber intraocular lenses. Retina 34:1977–1984. https://doi.org/10.1097/iae.0000000000000168 CrossRefPubMedGoogle Scholar
  15. 15.
    Olsen T, Dam-Johansen M (1994) Evaluating surgically induced astigmatism. J Cataract Refract Surg 20:517–522CrossRefPubMedGoogle Scholar
  16. 16.
    Alpins NA (1993) A new method of analyzing vectors for changes in astigmatism. J Cataract Refract Surg 19:524–533CrossRefPubMedGoogle Scholar
  17. 17.
    Alpins N (2001) Astigmatism analysis by the Alpins method. J Cataract Refract Surg 27:31–49CrossRefPubMedGoogle Scholar
  18. 18.
    Holladay JT, Dudeja DR, Koch DD (1998) Evaluating and reporting astigmatism for individual and aggregate data. J Cataract Refract Surg 24:57–65CrossRefPubMedGoogle Scholar
  19. 19.
    Hayashi K, Hayashi H, Nakao F, Hayashi F (1999) Intraocular lens tilt and decentration, anterior chamber depth, and refractive error after trans-scleral suture fixation surgery. Ophthalmology 106:878–882. https://doi.org/10.1016/s0161-6420(99)00504-7 CrossRefPubMedGoogle Scholar
  20. 20.
    Jeoung JW, Chung H, Yu HG (2007) Factors influencing refractive outcomes after combined phacoemulsification and pars plana vitrectomy: results of a prospective study. J Cataract Refract Surg 33:108–114. https://doi.org/10.1016/j.jcrs.2006.09.017 CrossRefPubMedGoogle Scholar
  21. 21.
    Asatryan SV, Surguch VK, Kharlap SI, Shchegoleva TA (2016) Biometric parameters of vitrectomized eyes. Vestn oftalmol 132:49–53CrossRefPubMedGoogle Scholar
  22. 22.
    Ma DJ, Choi HJ, Kim MK, Wee WR (2011) Clinical comparison of ciliary sulcus and pars plana locations for posterior chamber intraocular lens transscleral fixation. J Cataract Refract Surg 37:1439–1446. https://doi.org/10.1016/j.jcrs.2011.02.032 CrossRefPubMedGoogle Scholar
  23. 23.
    Naeser K (2001) Popperian falsification of methods of assessing surgically induced astigmatism. J Cataract Refract Surg 27:25–30CrossRefPubMedGoogle Scholar
  24. 24.
    Wirbelauer C, Hoerauf H, Roider J, Laqua H (1998) Corneal shape changes after pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol 236:822–828CrossRefPubMedGoogle Scholar
  25. 25.
    Weinberger D, Lichter H, Loya N, Axer-Siegel R, Muzmacher L, Gabbay U, Yassur Y (1999) Corneal topographic changes after retinal and vitreous surgery. Ophthalmology 106:1521–1524. https://doi.org/10.1016/s0161-6420(99)90447-5 CrossRefPubMedGoogle Scholar
  26. 26.
    Yuen CY, Cheung BT, Tsang CW, Lam RF, Baig NB, Lam DS (2009) Surgically induced astigmatism in phacoemulsification, pars plana vitrectomy, and combined phacoemulsification and vitrectomy: a comparative study. Eye (Lond) 23:576–580. https://doi.org/10.1038/eye.2008.57 CrossRefGoogle Scholar
  27. 27.
    Johnston RL, Charteris DG (2001) Pars plana vitrectomy and sutured posterior chamber lens implantation. Curr Opin Ophthalmol 12:216–221CrossRefPubMedGoogle Scholar
  28. 28.
    Oh SY, Lee SJ, Park JM (2015) Comparision of surgical outcomes of intraocular lens refixation and intraocular lens exchange with perfluorocarbon liquid and fibrin glue-assisted sutureless scleral fixation. Eye (Lond) 29:757–763. https://doi.org/10.1038/eye.2015.22 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Seung Yong Choi
    • 1
  • You Sook Hwang
    • 1
  • Mirinae Kim
    • 1
  • Soon Il Choi
    • 1
  • Young-Hoon Park
    • 1
    • 2
  1. 1.Department of Ophthalmology and Visual Science, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
  2. 2.Catholic Institute for Visual Science, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea

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