Sutureless intrascleral fixation using different three‐piece posterior chamber intraocular lenses: a literature review of surgical techniques in cases of insufficient capsular support and a retrospective multicentre study

摘要

Abstract We present a literature review of surgical techniques of intraocular lens placement in eyes with insufficient capsular support, focusing on the most recent publications, together with a retrospective multicentre consecutive case series analysis of 103 eyes undergoing pars plana vitrectomy and sutureless intrascleral ( SIS ) fixation of a standard three‐piece PCIOL . Many different approaches appear in the literature without any specific procedure achieving superior outcomes. Advantages and disadvantages vary between techniques. Common complications related to IOL fixation techniques were as follow: anterior chamber IOL : transient/permanent corneal oedema (9–66.6%), uveitis (1.1–39.3%); iris‐fixated IOL : pupil ovalization (16–47.7%); and sutured scleral‐fixated IOL : suture breakage/exposure (6.1–11%), vitreous haemorrhage: (5.5–16.6%). In our retrospective case series, indications for surgery were postoperative aphakia in 50 eyes (49%), IOL dislocation in 38 eyes (37%) and natural lens dislocation in 15 eyes (14%). Scleral tunnels for haptic fixation were created with (28 eyes, 27.2%) or without (75 eyes, 72.8%) 25 gauge trocar cannulas. Complications included transient hypotony ( n ?=?20; 19.4%), corneal decompensation ( n ?=?7; 6.7%), IOL dislocation ( n ?=?6; 5.8%), cystoid macular oedema ( n ?=?5; 4.8%), vitreous haemorrhage ( n ?=?4; 3.8%) and retinal detachment ( n ?=?4; 3.8%). Mean best corrected visual acuity improved from log MAR 0.65 to 0.36 at the final visit (p?=?0.001). In conclusion, SIS fixation provides good anatomical and functional outcomes; however, complications can occur. The number of surgical approaches for IOL dislocation described in the literature indicates that optimal treatment remains to be found.