Comparison of intraocular lens tilt after capsular sutured scleral fixation with capsular segments versus uneventful cataract surgery

Abstract

Purpose

To evaluate and compare intraocular lens (IOL) tilt between uneventful phacoemulsification with in-the-bag IOL implantation and sutured scleral fixation (SSF) of the lens bag with a capsular tension segment (type 6 D / Morcher) using a Sheimpflug camera.

Setting

Clinical Practice, Hospital. Barcelona and A Coruña, Spain.

Design

Retrospective, comparative multicenter study.

Methods

IOL tilt was compared between patients who underwent sutured scleral fixation with a capsular tension segment in a single eye (SSF group, n = 15) with patients who underwent uneventful IOL implantation (control group, n = 12) that were matched by biometric measurements. Post-operative refractive accuracy of biometric formulas by means of mean absolute error (MAE) was also reported. All patients underwent a general ophthalmic evaluation, anterior segment photography, and postoperative optical biometry (Zeiss IOLMaster® 500). In addition, IOL tilt was measured with a Scheimpflug camera (Pentacam R, Oculus Optikgerate Gmbh).

Results

Mean vertical tilt was similar in both groups (2.20+/-2.47° SSF vs 1.97 +/- 1.79° control; p = 0.836) but mean horizontal tilt tended to higher values in the SSF series (2.09 +/- 2.74° vs 0.94 +/- 1.17°; p = 0.139). Considering post-operative refractive error in diopters by MAE calculations, there was an underestimation of IOL power in the SSF group which was only statistically significant for Barrett Universal II (1.07 vs 0.32; p = 0.028) and Hill-RBF (0.95 vs 0.26; p = 0.024) formulas, but not for SRK/T (0.99 vs 0.42; p = 0.285) and Kane (0.96 vs 0.33; p = 0.083).

Conclusion

Sutured scleral fixation of capsular tension segments in the presence of zonular instability does not seem to induce clinically significant IOL tilt compared to uneventful cataract extraction cases.

Keywords

Dislocated crystalline lens < LENS / CATARACT IOLs < LENS / CATARACT phacoemulsification < LENS / CATARACT intraoperative complications of cataract surgery < LENS / CATARACT lens changes < LENS / CATARACT

Get full access to this article

View all access options for this article.

References

Jarrett

II . Dislocation of the lens. A study of 166 hospitalized cases. Arch Ophthalmol 1967; 78(3): 289–296.

Cross

Jensen

. Ocular manifestations in the Marfan syndrome and homocystinuria. Am J Ophthalmol 1973; 75(3): 405–420.

Jensen

Cross

Paton

. Ocular complications in the Weill-Marchesani syndrome. Am J Ophthalmol 1974; 77(2): 261–269.

Chandler

. Choice of treatment in dislocation of the lens. Arch Ophthalmol 1964; 71: 765–786.

Ahmed

Chen

Kranemann

, et al. Surgical repositioning of dislocated capsular tension rings. Ophthalmology 2005; 112(10): 1725–1733.

Weber

Cionni

. All about capsular tension rings. Curr Opin Ophthalmol 2015; 26(1): 10–15.

Hasanee

Butler

Ahmed

. Capsular tension rings and related devices: current concepts. Curr Opin Ophthalmol 2006; 17(1): 31–41.

Phillips

Pérez-Emmanuelli

Rosskothen

, et al. Measurement of intraocular lens decentration and tilt in vivo. J Cataract Refract Surg 1988; 14(2): 129–135.

de Castro

Rosales

Marcos

. Tilt and decentration of intraocular lenses in vivo from Purkinje and Scheimpflug imaging. Validation Study. J Cataract Refract Surg 2007; 33(3): 418–429.

10.

Sasaki

Sakamoto

Shibata

, et al. Measurement of postoperative intraocular lens tilting and decentration using Scheimpflug images. J Cataract Refract Surg 1989; 15(4): 454–457.

11.

Wang

Dong

Wang

, et al. IOL Tilt and decentration estimation from 3 dimensional reconstruction of OCT image. PLoS One 2013; 8(3): e59109.

12.

Hirnschall

Buehren

Bajramovic

, et al. Prediction of postoperative intraocular lens tilt using swept-source optical coherence tomography. J Cataract Refract Surg 2017; 43(6): 732–736.

13.

Wang

Guimaraes de Souza

Weikert

, et al. Evaluation of crystalline lens and intraocular lens tilt using a swept-source optical coherence tomography biometer. J Cataract Refract Surg 2019; 45(1): 35–40.

14.

Ashena

Maqsood

Ahmed

, et al. Effect of intraocular Lens tilt and decentration on visual acuity, dysphotopsia and wavefront aberrations. Vision (Basel) 2020; 4(3): 41.

15.

Holladay

Piers

Koranyi

, et al. A new intraocular lens design to reduce spherical aberration of pseudophakic eyes. J Refract Surg 2002; 18(6): 683–691.

16.

Yamane

Inoue

Arakawa

, et al. Sutureless 27-gauge needle-guided intrascleral intraocular lens implantation with lamellar scleral dissection. Ophthalmology 2014; 121(1): 61–66.

17.

Chen

Wang

, et al. Characteristics and factors associated with intraocular lens tilt and decentration after cataract surgery. J Cataract Refract Surg 2020; 46(8): 1126–1131.

18.

Liu

Cao

, et al. Evaluation of intraocular Lens tilt and decentration in congenital Ectopia Lentis by the Pentacam Scheimpflug system. J Ophthalmol 2022; 2022: 7246730.

19.

Park

Mukai

, et al. A 1-year prospective comparative study of sutureless flanged intraocular Lens fixation and conventional sutured scleral fixation in intraocular Lens dislocation. Ophthalmologica 2021; 244(1): 68–75.

20.

Khan

Gupta

Smith

, et al. Scleral fixation of intraocular lenses using Gore-Tex suture: clinical outcomes and safety profile. Br J Ophthalmol 2016; 100(5): 638–643.

21.

Bhojwani

Vasavada

, et al. Intraoperative performance and long-term postoperative outcomes after scleral fixation of IOLs with polytetrafluoroethylene suture. J Cataract Refract Surg 2020; 46(11): 1480–1486.

22.

Kokame

Yanagihara

Shantha

, et al. Long-term outcome of pars Plana vitrectomy and sutured scleral-fixated posterior chamber intraocular Lens implantation or repositioning. Am J Ophthalmol 2018; 189: 10–16.

23.

Siganos

Popescu

, et al. Clear lens extraction and intraocular lens implantation in Marfan's syndrome. J Cataract Refract Surg 2000; 26(5): 781–784.

24.

Belov

Potemkin

Nikolaenko

. Optimizatsiya rascheta intraokulyarnykh linz pri psevdoeksfoliativnom sindrome [Optimization of intraocular lens power calculation in pseudoexfoliation syndrome]. Vestn Oftalmol 2021; 137(4): 38–42.

25.

Tokuhisa

Watanabe

, et al. Refractive error induced by intraocular lens tilt after intrascleral intraocular lens fixation. Int Ophthalmol 2022; 42(4): 1213–1220.

26.

Huebscher

Fink

Steinbrück

, et al.

Scheimpflug records without distortion–a mythos?

Ophthalmic Res 1999; 31(2): 134–139.

27.

Koretz

Strenk

, et al. Scheimpflug and high-resolution magnetic resonance imaging of the anterior segment: a comparative study. J Opt Soc Am A Opt Image Sci Vis 2004; 21(3): 346–354.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.10 MB