Skip to main content

Advertisement

SpringerLink
Log in

Angle-supported intraocular lens versus scleral-sutured posterior chamber intraocular lens in post-cataract surgery aphakic patients: two-year follow-up cost-effectiveness analysis

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To compare visual, anatomical and economical outcomes of patients with secondary anterior chamber intraocular lens (AC-IOL) implantation and secondary scleral fixated intraocular lens (SF-IOL) implantation.

Methods

In this retrospective observational study, 38 aphakic patients after complicated phacoemulsification divided in two groups, AC-IOL group (17 patients receiving AC-IOL implantation) and SF-IOL group (21 patients receiving SF-IOL implantation). Corrected distance visual acuity (CDVA), patient reported visual outcome (VF-14) and endothelial cell density (ECD) were measured at baseline and two-year follow-up. Complication rate was registered. The global cost of each procedure and the incremental cost-effectiveness ratio (ICER) were calculated.

Results

No statistically significant difference was found in CDVA (logMAR 0.24 ± 0.17 vs. 0.32 ± 0.26, p = 0.27), VF-14 (68 ± 18 vs. 61 ± 20, p = 0.24), ECD (1456.48 ± 525.15 vs. 1341.71 ± 374.33, p = 0.48) and overall complication rate (p = 0.79) postoperatively between the SF-IOL group and the AC-IOL group. The ECD loss rate was significantly higher in the AC-IOL group (15.5% vs. 3.5%, p = 0.004). The average global cost of the two procedures was higher in the SF-IOL group (p < 0.005) and ICER showed an additional payment of 693 € for each patient in SF-IOL group against a saving of 186 endothelial cells 2 years postoperatively.

Conclusion

AC IOL and SF-IOL implantation showed similar outcomes in terms of visual function and safety profile. Higher ECD loss was found in AC-IOL group. The global cost of implantation was significantly lower for AC-IOL, but the ICER seems to justify the SF-IOL implantation in patients with low ECD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Olson RJ (2018) Cataract Surgery From 1918 to the Present and Future-Just Imagine! Am J Ophthalmol 185:10–13

    Article  Google Scholar 

  2. Kim EJ, Brunin GM, Al-Mohtaseb ZN (2016) Lens placement in the absence of capsular support: scleral-fixated versus iris-fixated IOL versus ACIOL. Int Ophthalmol Clin 56(3):93–106

    Article  Google Scholar 

  3. Sorenson R, Scott IU, Tucker SH, Chinchilli VM, Papachristou GC (2016) Practice patterns of cataract surgeons at academic medical centers for the management of inadequate capsule support for intracapsular or sulcus intraocular lens placement during cataract surgery. J Cataract Refract Surg 42(2):239–245

    Article  Google Scholar 

  4. Wagoner MD, Cox TA, Ariyasu RG, Jacobs DS, Karp CL (2003) Intraocular lens implantation in the absence of capsular support: a report by the American Academy of Ophthalmology. Ophthalmology 110(4):840–859

    Article  Google Scholar 

  5. Donaldson KE, Gorscak JJ, Budenz DL, Feuer WJ, Benz MS, Forster RK (2005) Anterior chamber and sutured posterior chamber intraocular lenses in eyes with poor capsular support. J Cataract Refract Surg 31(5):903–909

    Article  Google Scholar 

  6. Kwong YY, Yuen HK, Lam RF, Lee VY, Rao SK, Lam DS (2007) Comparison of outcomes of primary scleral-fixated versus primary anterior chamber intraocular lens implantation in complicated cataract surgeries. Ophthalmology 114(1):80–85

    Article  Google Scholar 

  7. Hazar L, Kara N, Bozkurt E, Ozgurhan EB, Demirok A (2013) Intraocular lens implantation procedures aphakic eyes with insufficient capsular support associated with previous cataract surgery. J Refract Surg 29(10):685–691

    Article  Google Scholar 

  8. Chan TC, Lam JK, Jhanji V, Li EY (2015) Comparison of outcomes of primary anterior chamber versus secondary scleral-fixated intraocular lens implantation incomplicated cataract surgeries. Am J Ophthalmol 159(2):221–6.e2

    Article  Google Scholar 

  9. Melamud A, Topilow JS, Cai L, He X (2016) Pars plana vitrectomy combined with either secondary scleral-fixated or anterior chamber intraocular lens implantation. Am J Ophthalmol 168:177–182

    Article  Google Scholar 

  10. Khan MA, Gupta OP, Pendi K, Chiang A, Vander J, Regillo CD, Hsu J (2019) Pars plana vitrectomy with anterior chamber versus gore-tex sutured posterior chamber intraocular lens placement: long-term outcomes. Retina 39(5):860–866

    Article  Google Scholar 

  11. Ning X, Yang Y, Yan H, Zhang J (2019) Anterior chamber depth—a predictor of refractive outcomes after age-related cataract surgery. BMC Ophthalmol 19(1):134

    Article  Google Scholar 

  12. Khadka J, Huang J, Mollazadegan K, Gao R, Chen H, Zhang S, Wang Q, Pesudovs K (2014) Translation, cultural adaptation, and Rasch analysis of the visual function (VF-14) questionnaire. Invest Ophthalmol Vis Sci 55(7):4413–4420. https://doi.org/10.1167/iovs.14-14017 (PMID: 24917139)

    Article  PubMed  Google Scholar 

  13. Zheng T, Le Q, Hong J, Xu J (2016) Comparison of human corneal cell density by age and corneal location: an in vivo confocal microscopy study. BMC Ophthalmol 16(16):109. https://doi.org/10.1186/s12886-016-0290-5.PMID:27422394;PMCID:PMC4947260

    Article  PubMed  PubMed Central  Google Scholar 

  14. Schulze SD, Bertelmann T, Manojlovic I, Bodanowitz S, Irle S, Sekundo W (2015) Changes in corneal endothelium cell characteristics after cataract surgery with and without use of viscoelastic substances during intraocular lens implantation. Clin Ophthalmol 6(9):2073–2080. https://doi.org/10.2147/OPTH.S90628.PMID:26609218;PMCID:PMC4644175

    Article  Google Scholar 

  15. Davies EC, Pineda R (2018) Complications of Scleral-Fixated Intraocular Lenses. Seminars in Ophthalmology 33(1):23–28

    Article  Google Scholar 

  16. Maxwell S, Stem MD, Todorich B, Maria A, Woodward MD, Hsu J, Wolfe JD (2017) Scleral-Fixated Intraocular Lenses: Past and Present. J Vitreoretin Dis 1(2):144–152

    Article  Google Scholar 

  17. Apple DJ, Brems RN, Park RB, Norman DK, Hansen SO, Tetz MR, Richards SC, Letchinger SD (1987) Anterior chamber lenses. Part I: complications and pathology and a review of designs. J Cataract Refract Surg 13:157–174

    Article  CAS  Google Scholar 

  18. Apple DJ, Hansen SO, Richards SC, Ellis GW, Kavka-Van Norman D, Tetz MR, Pfeffer BR, Park RB, Crandall AS, Olson RJ (1987) Anterior chamber lenses. Part II: a laboratory study. J Cataract Refract Surg 13:175–18914

    Article  CAS  Google Scholar 

  19. Glasser DB, Matsuda M, Gager WE, Edelhauser HF (1985) Corneal endothelial morphology after anterior chamber lens implantation. Arch Ophthalmol 103:1347–1349

    Article  CAS  Google Scholar 

  20. Sawada T, Kimura W, Kimura T, Suga H, Ohte A, Yamanishi S, Ohara T (1998) Long-term follow-up of primary anterior chamber intraocular lens implantation. J Cataract Refract Surg 24:1515–1520

    Article  CAS  Google Scholar 

  21. Auffarth GU, Wesendahl TA, Brown SJ, Apple DJ (1994) Are there acceptable anterior chamber intraocular lenses for clinical use in the 1990s? An analysis of 4104 explanted anterior chamber intraocular lenses. Ophthalmology 101(12):1913–1922

    Article  CAS  Google Scholar 

  22. Dick HB, Augustin AJ (2001) Lens implant selection with absence of capsular support. Curr Opin Ophthalmol 12:47–57

    Article  CAS  Google Scholar 

  23. Tuberville AW, Wood TO (1990) Aqueous humor protein and complement in pseudophakic eyes. Cornea 9:249–253

    Article  CAS  Google Scholar 

  24. Hull DS, Green K, Thomas L, Alderman N (1984) Hydrogen peroxide/mediated corneal endothelial damage; induction by oxygen free radical. Invest Ophthalmol Vis Sci 25:1246–1253

    CAS  PubMed  Google Scholar 

  25. Por YM, Lavin MJ (2005) Techniques of intraocular lens suspension in the absence of capsular/zonular support. Surv Ophthalmol 50(5):429–462

    Article  CAS  Google Scholar 

  26. Ravalico G, Botteri E, Baccara F (2003) Long-term endothelial changes after implantation of anterior chamber intraocular lenses in cataract surgery. J Cataract Refract Surg 29(10):1918–1923

    Article  Google Scholar 

  27. Holland EJ, Daya SM, Evangelista A, Ketcham JM, Lubniewski AJ, Doughman DJ, Lane SS (1992) Penetrating keratoplasty and transscleral fixation of posterior chamber lens. Am J Ophthalmol 114(2):182–187

    Article  CAS  Google Scholar 

  28. Teng H, Zhang H (2014) Comparison of Artisan iris-claw intraocular lens implantation and posterior chamber intraocular lens sulcus fixation for aphakic eyes. Int J Ophthalmol 7(2):283–287. https://doi.org/10.3980/j.issn.2222-3959.2014.02.16.PMID:24790871;PMCID:PMC4003083

    Article  PubMed  PubMed Central  Google Scholar 

  29. Panton RW, Viana MG, Panton PJ, Panton JH (2000) Long-term follow-up of leiske closed-loop anterior chamber intraocular lenses. J Cataract Refract Surg 26(4):590–596

    Article  CAS  Google Scholar 

Download references

Funding

None to disclose.

Author information

Authors and Affiliations

  1. University Eye Clinic, San Giuseppe Hospital, IRCCS MultiMedica, Via San Vittore 12, 20123, Milan, MI, Italy

    Stefano Ranno, Giovanni Mario Rabbiolo, Stefano Lucentini, Edoardo Ruggiero, Saverio Vincenzo Luccarelli & Paolo Nucci

  2. Plannin & Control Department, San Giuseppe Hospital, IRCCS MultiMedica, Milan, Italy

    Linda Lombardi

  3. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Paolo Nucci

Authors
  1. Stefano Ranno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giovanni Mario Rabbiolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefano Lucentini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edoardo Ruggiero
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Saverio Vincenzo Luccarelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Linda Lombardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paolo Nucci
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stefano Ranno.

Ethics declarations

Conflict of interest

None to disclose.

Consent for publication

We give the approval for publication.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ranno, S., Rabbiolo, G.M., Lucentini, S. et al. Angle-supported intraocular lens versus scleral-sutured posterior chamber intraocular lens in post-cataract surgery aphakic patients: two-year follow-up cost-effectiveness analysis. Int Ophthalmol 42, 871–879 (2022). https://doi.org/10.1007/s10792-021-02068-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-021-02068-6

Keywords

Search

Navigation