RESUMO
Objective: Successful intraocular lens (IOL) placement in cataract surgery is synonymous with the IOL being placed in the capsular bag. When the capsular bag is violated, the ciliary sulcus becomes an option to approximate an in- the-bag position. Studies report that single-piece foldable acrylic (SPA) IOLs are a poor choice for the sulcus. This study aimed to report the visual outcomes and complications of sulcus placement of single-piece intraocular lenses and three-piece intraocular lenses, and compare the design and characteristics to the occurrences of complications. Methods: The medical records of patients were retrospectively reviewed in a single center from 2016-2019. Results: A total of 245 eyes from 237 patients were included in the study with a mean age of 61 years and male predominance. Majority of sulcus implantation occurred during phacoemulsification (87%). Around 82% (n=202) were implanted with single-piece IOLs and 18% (n=43) were three-piece IOLs. Best corrected distance visual acuity (BCDVA) was 20/20 after six months for both groups. Comparison between two groups showed no superiority with each other. Complications notable were elevated intraocular pressure, corneal edema, loss of IOL centration, and pigment dispersion. Smaller optic diameter and overall length predispose to higher probabilities of loss of centration. Pliability, hydrophobicity/hydrophilicity, and material do not correlate with postoperative complications. There were significantly higher numbers of pigment dispersions in IOLs with square-edged design. Conclusions: In conclusion, visual outcomes remain equally excellent for both single-piece and three-piece groups. In contrast, there were more notable complications in single-piece group. Loss of centration tends to occur more with mean optic diameters lower than or equal to 5.50 mm and an overall length of less than 12.50 mm or lower. While appropriate for the capsular bag, square-edged designs were found to be inappropriate for the sulcus. The retrospective design does not allow strong inferences hence caution should be taken in correlating results.
RESUMO
OBJECTIVE: This study determined the risk of postoperative visual loss and the factors affecting the decrease in visual acuity in patients with advanced glaucoma who underwent trabeculectomy or combined cataract surgery. METHODS: Charts of patients with advanced glaucoma who underwent trabeculectomy or combined cataract surgery were reviewed for the following parameters: visual acuity (VA), intraocular pressure (IOP), and visual-field indices of the Humphrey perimetry. Eyes that lost 2 or more Snellen lines or worsened one category two months after surgery were identified. Central vision was lost (wipeout) when best corrected VA was less than 20/200, characterized as a sudden, permanent, and unexplained visual loss within 2 months post-operatively. Analysis of variance (ANOVA) determined the differences between groups and logistic regression analyzed the factors affecting the decrease in visual acuity postoperatively. RESULTS: Ninety-eight eyes of 92 patients aged 18 years and older were included in the study. The incidence of postoperative visual loss 2 months after surgery was 20 percent (20/98), of which 3 percent (3/98) was considered "wipeout." Factors affecting the decrease in VA postoperatively include the presence of surgical complications (p = 0.04) and increase in postoperative IOP at two months (p = 0.05). CONCLUSION: The incidence of wipeout among patients with advanced glaucoma who underwent trabeculectomy or combined cataract surgery is low and generally occurs in patients with central-splitting fixation. Surgical complications play a major role in causing postoperative decrease in VA.