Purpose:

To report the results of intrascleral IOL fixation in patient who had lens lunation combined with retinal detachment (RD) surgery.

Methods:

Forty-seven eyes of 47 patients with a diagnosis of RD combined with lens luxation were enrolled into this prospective non-randomised study. Pre- and postoperative standard ophthalmic examination was performed in all patients. Surgery included either phacoemulsification or phacofragmentation of the luxated lens, pars plana vitrectomy, intrascleral 3-piece IOL (MA60AC, Alcon, Fort Worth, TX, USA) fixation by Scharioth, endolaser and gas or silicon oil endotamponade. The position and stability of the IOL were assessed clinically and using anterior segment optic coherence tomography (OCT) on the first day, and at 1 and 4 weeks after surgery.

Results:

The time of the procedure decreased from 30 minutes at the beginning of the study to 7 minutes after 10 cases, excluding the time for suturing. Endolaser and endotamponade were performed after the IOL was fixed. In cases with gas endotamponade a slight deterioration of the fundus view occurred after fluid-air exchange, especially when the air filled the anterior chamber. However, this did not impact much on the remaining workflow. OCT showed the lens to be sitting in a similar distance between the iris and IOL at 12, 3, 6, and 9 o’clock positions. Transient hypotony occurred in 9 eyes on the first postoperative day. Haptic extrusion out of the scleral tunnel was observed in 6 cases, but with no impact on IOL position. In 1 case there was an extrusion of the IOL haptic into the vitreous cavity but that was easily restored. In 2 cases the proximal haptic was broken off and that required IOL removal and intrascleral fixation of a new 3-piece IOL.

Conclusion:

Intrascleral fixation of the MA60AC 3-piece IOLs is an effective technique in the treatment of patients with luxated lens combined with RD but requires a learning curve. The procedure achieves good centeration and stable position of the IOL during and after the surgery with minor impact on intraoperative posterior segment visualisation.

Contact Details:

Email: lubko_l@yahoo.co.uk
Cell Phone: +380676708355