Elsevier

Ophthalmology

Volume 106, Issue 5, 1 May 1999, Pages 878-882
Ophthalmology

Intraocular lens tilt and decentration, anterior chamber depth, and refractive error after trans-scleral suture fixation surgery1

https://doi.org/10.1016/S0161-6420(99)00504-7Get rights and content

Abstract

Objectives

To compare the extent of intraocular lens (IOL) tilt and decentration, as well as the anterior chamber depth after trans-scleral suture IOL fixation after either secondary out-of-the-bag or primary in-the-bag IOL implantation.

Design

Retrospective, comparative, nonrandomized, interventional study.

Participants

Fifty-two eyes that underwent scleral suture fixation were compared with 51 eyes that underwent secondary out-of-the-bag implantation and 50 eyes that underwent in-the-bag implantation.

Intervention

One-piece polymethyl methacrylate IOL implantation by three different techniques.

Main outcome measures

The tilt angle and decentration length of the IOL, as well as the anterior chamber depth, were measured by the Scheimpflug videophotography system. The spherical equivalent error from the predicted value was also examined.

Results

The mean tilt angle in the scleral suture fixation group was significantly greater than that in either the out-of-the-bag or the in-the-bag implantation group (P < 0.0001). The mean decentration length was also largest in the suture group, followed by the out-of-the-bag group and the in-the-bag group (P < 0.0001). The anterior chamber depth in the suture group and the out-of-the-bag group was significantly smaller than that in the in-the-bag group (P < 0.0001). The spherical equivalent error in the suture group and the out-of-the-bag group was also greater than that in the in-the-bag group (P < 0.0001).

Conclusions

The extent of both tilt and decentration after scleral suture fixation was greater than that observed after either out-of-the-bag or in-the-bag implantation. The anterior chamber depth with the sutured or out-of-the-bag fixated IOL was shallower than that with the in-the-bag fixated IOL, which resulted in a significant myopic shift.

Section snippets

Patients and methods

We examined 52 eyes from 49 consecutive patients who had undergone trans-scleral PC-IOL suture fixation, 51 eyes from 43 consecutive patients who had undergone secondary out-of-the-bag implantation after previous extracapsular cataract surgery, and 50 eyes from 50 patients who had undergone phacoemulsification surgery with in-the-bag implantation. All procedures were performed between March 1994 and November 1997. These eyes were selected because they all had a minimum follow-up of 3 months. Of

Results

The average ± SD patient age was 63.9 ± 14.0 years (range 17 to 87). The patients were 80 men and 73 women; their characteristics are given in Table 1. The mean age in the suture group was significantly younger than that in either the out-of-the-bag or the in-the-bag group. However, no statistically significant differences were found between the three groups regarding gender, the ratio of the left and right eyes, or the interval between the surgery and EAS-1000 examination.

Table 2 summarizes

Discussion

In the trans-scleral suture fixation of PC-IOL, the surgeon generally attempts to fix the haptics in the ciliary sulcus.1, 2, 3, 4, 5, 6, 7, 8, 19 However, ultrasound biomicroscopic studies have shown most haptics not to be located in the sulcus.17, 18 Furthermore, it is also difficult to accurately introduce the haptics into the sulcus, even if needles are penetrated into the sulcus. Therefore, the actual extent of both the IOL tilt and decentration may be greater than has been reported.1, 2, 3

References (26)

Cited by (0)

1

The authors have no proprietary interest in any of the materials described in this article.

View full text