ABSTRACT
Purpose@#The aim of this study was to determine the surgical and visual outcomes of scleral fixated intraocular lens implantation in eyes with as subluxated and dislocated crystalline lens or traumatic aphakic eyes.@*Methods@#A retrospective and short-term prospective cohort study was carried out in 45 eyes of 43 individuals who underwent SFIOL implantation surgery in First Central Hospital of Mongolia between January 2017 and January 2020 and had a minimum follow-up of 3 months. Pre-operative and post-operative best corrected visual acuity, postoperative outcomes and complications were summarized. Patients after the implantation of a scleral fixated PCIOL were evaluated for the disease etiology, pre- and post-operative best corrected visual acuity, and occurrence of postoperative complications.@*Results@#The analysis included 45 eyes from 43 patients. Thirty-two (74.4%) patients were men and eleven (24.6%) were women . The mean age at implantation was 57.2 ± 20.0. Indications for the IOL implantation included ocular trauma (48.9%), pseudoexfoliation syndrome (22.2%) and Marfan syndrome (15.6%). Disease etiology and age group were compared and results were Marfan syndrome is mostly diagnosed in 20-29 years of age, ocular trauma is usually diagnosed in 30-69 years of age and pseudoexfoliation syndrome is occurred in 70 and above of age. Post-operative visual acuity was improved in all cases from which 35 of patients (77.77%) visual outcome was 6/12 and above. </br> The mean preoperative best corrected visual acuity (BCVA) was 0.083 ± 0.088, which improved to 0.569 ± 0.221 (p<0.001) third month postoperatively and these were statistically significant.</br> The most frequent complication was induced astigmatism, which occurred in 6 eyes which successfully corrected with glasses. Suture erosion occurred in three eyes which successfully relocate it. The most serious complications such as vitreous hemorrhage, retinal detachment, suprachoroidal hemorrhage, endophthalmitis and suture degradation or breakage was not seen.@*Conclusion@#Ab externo SFIOL implantation is a reasonable technique for the management of eyes with aphakia or absence of capsular support, with relatively high visual outcomes and few serious complications.</br> The most frequent cause of aphakia and absence of capsular support was ocular trauma thus, pseudoexfoliation and Marfan syndrome were the most common in elderly and in young age, respectively.
ABSTRACT
RESUMEN La extracción del cristalino en pacientes con ectopia lentis se convierte en una cirugía desafiante para el cirujano. En el pasado surgieron serias complicaciones asociadas a esta intervención quirúrgica, como desprendimiento de retina y glaucoma. El avance de las técnicas quirúrgicas en las últimas décadas ha brindado mayor seguridad para la cirugía de esta afección del cristalino. Se presenta una paciente femenina de 47 años aquejada de disminución de la visión. Al examen oftalmológico se encuentra subluxación superior del cristalino bilateral. Previa discusión con la paciente de los posibles escenarios a presentarse durante la cirugía, se le sugiere una facoemulsificación bilateral secuencial del cristalino conservando el saco capsular mediante la colocación de un anillo de tensión capsular fijado a la esclera más implante de lente intraocular plegable en el saco capsular. Se realiza primeramente cirugía del ojo izquierdo y se presenta un desgarro radial de la rexis con extensión posterior, por lo que se varía el abordaje quirúrgico y se fija el implante al iris. Un mes después se realiza cirugía del ojo derecho siguiendo el plan quirúrgico inicial sin complicaciones. La recuperación visual fue satisfactoria (0,7 en cartilla de Snellen) en ambos ojos y se demostró la efectividad de ambas alternativas quirúrgicas. La planificación correcta de la técnica quirúrgica y de las posibles modificaciones ante circunstancias sobrevenidas, así como la oportuna información preoperatoria y la experiencia del cirujano resultan fundamentales para alcanzar el éxito quirúrgico, la recuperación funcional y la satisfacción del paciente(AU)
ABSTRACT Crystalline lens removal in patients with ectopia lentis is a challenge for eye surgeons. Serious complications, such as retinal detachment and glaucoma, were associated in the past to this surgical procedure. However, the progress in surgical techniques achieved in recent decades provides greater safety in the surgical treatment of this lens disorder. A female 47-year-old patient attends consultation complaining of vision reduction. Ophthalmological examination reveals bilateral crystalline lens upper subluxation. The possible scenarios to occur during surgery are discussed with the patient, and it is suggested that she undergoes sequential bilateral lens phacoemulsification preserving the capsular bag with the placement of a capsular tension ring fixed to the sclera plus implantation of a foldable intraocular lens in the capsular bag. The first eye to be operated on is the left eye, and radial tear of the rhexis with posterior extension occurs. Therefore, the surgical approach is changed and the implant is fixed to the iris. Surgery of the right eye is performed one month later, following the initial surgical plan without any complications. Visual recovery was satisfactory (0.7 by the Snellen chart) in both eyes, proving the effectiveness of both surgical alternatives. Correct planning of the surgical technique and its possible modifications in response to unexpected circumstances, alongside timely preoperative information and the surgeon's experience, are all crucial to achieve surgical success, functional recovery and patient satisfaction(AU)
Subject(s)
Humans , Female , Middle Aged , Ectopia Lentis/surgery , Lens Subluxation/etiology , Phacoemulsification/methodsABSTRACT
PURPOSE: The purpose of this study is to evaluate and to compare the results of primary and secondary scleral-fixated posterior chamber intraocular lens (PCIOL) implantations in adult patients. MATERIALS AND METHODS: A retrospective analysis of scleral-fixated PCIOLs-implanted during (primary group) or after (secondary group) cataract surgery was performed. The median follow-up time of 96 patients was 6 months (minimum: 6; maximum: 35 months). Outcome measures were indications, corrected distance visual acuity (CDVA), change in visual acuity and complications. RESULTS: A total of 37 patients (38.5%) had primary implantations and 59 (61.5%) had secondary implantations. Penetrating keratoplasty was combined with secondary implantation in 13 cases. The median post-operative CDVA was 0.5 in decimal notation in both groups (P = 0.576). The CDVA improved by at least one Snellen line or remained unchanged in 35 eyes (94.6%) in the primary group and in 52 eyes (88.1%) in the secondary group (P = 0.263). Eyes with CDVA of 0.5 or higher were 62.2% (n = 23) in the primary group and 67.8% (n = 40) in the secondary group post-operatively (P = 0.066). The difference in early and late complications were not statistically significant between groups (P = 0.637, P = 0.154, respectively). Regarding late complications, 30 eyes (81%) in the primary group and 40 eyes (67.9%) in the secondary group had no complications (P = 0.154). CONCLUSION: Both primary and secondary scleral-fixated PCIOL implantations can provide favorable visual outcomes with lower complication rates. An important consideration is the appropriate timing for scleral fixation, taking into account the patient's characteristics and the course of the operation.
