Comparison of three types of scleral fixation of the intraocular lens

Abstract

Purpose: This study aimed to compare the 1-year clinical outcomes of three scleral fixation techniques for intraocular lens (IOL) implantation: ab externo scleral fixation, trocar-cannula-based sutureless fixation (“sutureless fixation”), and four-point scleral fixation. Methods: This retrospective study evaluated 77 consecutive eyes treated with scleral fixation of the IOL. The ab externo method utilized conventional sutured techniques, while the trocar-cannula-based sutureless method was adapted from the “Yamane” technique, employing a wide-angle fundus lens to facilitate IOL manipulation in the vitreous cavity. The four-point fixation method involved a double-armed polypropylene suture and two 26-gauge needles to secure the four IOL haptics at four distinct sites. One-way analysis of variance (ANOVA) was used for statistical comparison between the groups. Results: The four-point fixation group exhibited superior best-corrected visual acuity compared to the sutureless and ab externo groups at 1 and 3 months postoperatively (P = 0.004 and P = 0.002, respectively), along with significantly less surgically induced astigmatism (P < 0.001). The sutureless group had the shortest operative time, while the ab externo group had the longest (P < 0.001). No instances of IOL iris capture occurred in the four-point group, while three cases (10.0%) were noted in the sutureless group. Conclusion: The four-point fixation technique provides significant benefits, including faster visual recovery, enhanced IOL stability, and lower surgically induced astigmatism (SIA) values. The sutureless technique provides the benefit of shorter operative times but does pose a risk of IOL capture in a limited number of cases.

Keywords

• four-point scleral fixation
• surgically induced astigmatism
• sutureless scleral fixation
• trocar-cannula-based technique