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Long-term outcomes of modified glued versus flanged intrascleral haptic fixation techniques for secondary intraocular lenses

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Abstract

Purpose

To report the long-term refractive outcomes and complications of two scleral fixation techniques for secondary intraocular lenses (IOL).

Methods

Consecutive patients who underwent secondary IOL insertion at a tertiary care academic hospital using either modified glued (“glued”) or flanged intrascleral haptic fixation (FISHF) techniques with over 12 months of follow-up were retrospectively reviewed. Pre- and postoperative corrected distance visual acuity (CDVA), postoperative complications, and refractive surprises were reported.

Results

Thirty-eight patients underwent “glued” fixation and 22 underwent FISHF, with mean follow-up times of 3.1 ± 0.5 and 2.0 ± 1.2 years, respectively. Aphakia secondary to trauma was the main surgical indication. MA50BM or MA60AC IOLs (Alcon Laboratories Inc., Fort Worth, TX) were implanted in 92% of “glued” patients, while CT Lucia 602 IOLs (Carl Zeiss Meditec Inc., Dublin, CA) were used in 96% of FISHF patients. Postoperative spherical equivalent significantly improved compared to preoperative values (p < 0.001). No significant difference in CDVA was seen between the two techniques. FISHF resulted in mean hyperopic surprises of + 0.81D and + 0.69D using the Holladay 2 and Barrett Universal II formulae, respectively, which was significantly greater than the “glued” patients. A higher rate of IOL dislocation was seen in the “glued” cohort (13%) compared to FISHF (0%).

Conclusions

Retrospective long-term outcomes of patients with complex ocular comorbidities undergoing a modified “glued” technique demonstrated a higher rate of IOL dislocation but more predictable refractive outcomes compared to the FISHF technique. The FISHF technique resulted in a significant hyperopic shift using fourth-generation IOL calculators.

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Authors and Affiliations

  1. Department of Ophthalmology, University of Washington, Seattle, WA, 98104, USA

    Amy Yuan, Debarshi Mustafi & Kasra A. Rezaei

  2. Northwest Eye Surgeons, Seattle, WA, USA

    Michael R. Banitt

Authors
  1. Amy Yuan
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  2. Debarshi Mustafi
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  4. Kasra A. Rezaei
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Correspondence to Kasra A. Rezaei.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board at the University of Washington and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Supplementary file1 Video 1 Video demonstrating the modified “glued” technique with a haptic fixation suture, applied to scleral refixation of a dislocated 3-piece IOL that was salvaged from the posterior segment in this example (MOV 11897 KB)

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Yuan, A., Mustafi, D., Banitt, M.R. et al. Long-term outcomes of modified glued versus flanged intrascleral haptic fixation techniques for secondary intraocular lenses. Graefes Arch Clin Exp Ophthalmol 260, 2887–2895 (2022). https://doi.org/10.1007/s00417-022-05647-0

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  • DOI: https://doi.org/10.1007/s00417-022-05647-0

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