Inverted implantation of posterior iris-fixated intraocular lens with 23G transconjunctival vitrectomy in the management of secondary implant. Technique and stability, astigmatism and endothelial loss outcomes
2014
PURPOSE: To study outcomes and complications and evaluate the safety and efficacy of
23-gauge transconjunctival sutureless vitrectomy (23G PPV) to remove vitreous adhesions
of dislocated or subluxated lens and in aphakia, combined with inverted implantation of
posterior Artisan® iris-fixated intraocular lens.
SETTING: Ophthalmology Unit. Hospital Universitari Germans Trias i Pujol, Spain.
METHODS: 23G PPV was combined with iris-claw implantation and incision in the
steepest meridian in 32 patients. Patients were followed-up for one year.
RESULTS: Complications: one bleeding in an acenocoumarol user, one intraoperative
dislocation, one accidental iridotomy, five postoperative subluxations. No complications
such as cystoid macular edema, retinal detachment or choroid were recorded. Refraction
was measured after a mean of 59.9 days. The corrected distance visual acuity (CDVA) was
0.17 ± 0.33 logMAR (0.67 ± 0.27) and, when the six patients with poor prognosis were
excluded from the group, CDVA was 0.10 ± 0.06 logMAR (0.79 ± 0.11). Visual acuity of
over 0.5 was achieved in 81.25% of all patients. Spherical equivalent was 0.07 ± 0.59, and
87.1% were within the range of ± 1 D. Astigmatism by subtraction was 0.69 ± 0.93 D,
and by vector 1.35 ± 0.57 D. There were no differences regarding incision location
(p = 0.941) or the eye involved (p = 0.563). The mean endothelial cell density at baseline
was 1546 ± 422 cells/mm2
and the final value was 1322 ± 360 cells/mm2
. Total cell loss was
13.6%, in aphakia 6.2%, in replacement 11.8%, in subluxated lens 12.6%, in dislocated lens
19.7%. Only 25% of the lenses would have been further than 3 mm from the endothelium
if the implant had been anterior.
CONCLUSION: This combined technique is safe, effective and predictable. Its major
complication is early haptic dislocation, which is simple to resolve. The 23G PPV provides
excellent treatment of the posterior cavity and prevents further complications.
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