Clinical Outcomes and Intraocular Pressure Control After Scleral-glued Intraocular Lens Insertion in Eyes With Pseudoexfoliation:

Postoperative complications of intrascleral intraocular lens fixation: A systematic review and meta-analysis

Our systematic review and meta-analysis elucidates the postoperative complication rates associated with 3 major surgical approaches, including the scleral tunnel, glued, and flanged techniques, for sutureless intrascleral intraocular lens (IOL) fixation. An online search was performed for articles published in PubMed and EMBASE between January 1, 1975, and January 7, 2023. Original studies reporting postoperative complications of sutureless intrascleral IOL fixation were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The initial search yielded 1854 articles, from which 1797 were excluded; 57 and 51 were included in the qualitative synthesis and meta-analysis, respectively. Based on the meta-analysis, the postoperative complication rates of cystoid macular edema (5.7 %), retinal detachment (3.5 %), vitreous hemorrhage (8.8 %), and hypotony (5.5 %) were highest with the scleral tunnel technique. The glued technique had the highest complication rate for corneal edema (14.2 %). The rates of temporarily elevated intraocular pressure (9.9 %), iris capture (5.4 %), haptic exposure (6.5 %), and IOL decentration (7.3 %) were the highest with the flanged technique. The flanged technique had a significantly shorter operative time (median, 17.1 min) compared with the scleral tunnel (42.7 min) and glued (56.5 min) techniques. Postoperative best-corrected visual acuity with the flanged technique was significantly better than that with the other techniques (P = 0.017). This meta-analysis identified high postoperative complication rates related to the impact of surgical manipulations with the scleral tunnel technique and IOL placement stability with the flanged technique. These findings enable surgeons to minimize postoperative complications in high-risk patients.

Late in-the-bag intraocular lens dislocation

This review aimed to evaluate the cumulative incidence, patient characteristics, predisposing conditions, and treatment outcomes for late in-the-bag intraocular lens (IOL) dislocation. Literature searches in PubMed (MEDLINE), Embase, and Cochrane Library Central database identified 1 randomized clinical trial, 1 prospective case series, 2 prospective cohort studies, and 36 retrospective studies of this condition, which showed that the cumulative incidence was 0.5% to 3%, it occurred on average 6 to 12 years after cataract surgery, and mean patient age was 65 to 85 years. Pseudoexfoliation syndrome, myopia, and previous vitreoretinal surgery were the most common predisposing conditions. Studies indicated that IOL repositioning and IOL exchange provided similar visual outcomes and were equally safe. The long-term visual outcome seemed satisfactory. However, the quality of evidence regarding treatment was in general quite low. More studies of late in-the-bag IOL dislocation are needed, and in particular, different surgical techniques should be included in high-quality clinical trials.

Intraocular lens implantation in the absence of capsular support: scleral-fixated vs retropupillary iris-claw intraocular lenses

Cataract surgery via phacoemulsification with intraocular lens (IOL) placement in the capsular bag is the gold standard in the presence of adequate capsular support. However, when capsule and/or zonular fibers are weak or absent, alternate fixation strategies are required. Common alternative options include retropupillary iris-claw IOLs (RP-IC IOLs) and scleral-fixated IOLs (SF IOLs). In the present review of 87 articles with 2174 eyes implanted with RP-IC IOLs and 2980 eyes with SF IOLs, we discuss the published literature with respect to safety and efficacy. Although the studies reporting outcomes of these IOLs have been performed in patients with different concomitant conditions, visual and refractive outcomes were found to be comparable between RP-IC IOLs and SF IOLs. RP-IC IOL implantation seemed to provide equivalent or a potentially lower rate of complications than SF IOL implantation. Data from the literature also suggest that the surgical technique of RP-IC IOL implantation is relatively simpler with correspondingly shorter surgical times.

Diagnostic imaging versus surgical procedure: intra- and postoperative OCT evaluation of sutureless scleral-fixated intraocular lens implantation and possible related complications

Because the popularity of corneal refractive surgery has been increasing throughout the last 25 years, many authors have thought to apply optical coherence tomography (OCT) to the anterior segment (AS-OCT); by revising the instrumentation needed and slightly improve the technique, it has become an element of vital importance in order to ensure a complete and exhaustive pre- and postsurgical evaluation. Many applications of OCT have been recently developed—mostly in cataract surgery due to the increasing numbers—such as chamber biometry, which is used in a preoperative stage to determine the details of IOL implantation, and lens evaluation. The aim of this review is to assess the applications of anterior segment OCT in dislocated IOL and/or capsular bag exchange surgery with scleral sutureless fixated intraocular lens and monitoring of possible postoperative complications.