Clinical Outcomes of Iris vs. Scleral Intraocular Lens Fixation

Background: We aimed to compare the safety and efficacy of two techniques for the correction of subluxated posterior intraocular lens (IOL): scleral fixation (SFIOL) and iris fixation of IOL (IFIOL). Methods: 112 eyes of 105 patients that underwent SFIOL or IFIOL at the Kaplan Medical Center between 2008 and 2018 were retrospectively included, 73 eyes had SFIOL and 39 eyes had IFIOL. The main outcome measures were: operation time, postoperative visual acuity and intra and post-operative complications. Results: There was no significant difference in the mean operation time between SFIOL and IFIOL. The mean follow-up time was significantly longer for the IFIOL compared with the SFIOL (34 ± 31 vs. 14 ± 20 months, respectively [p>0.001]).Postoperative distance corrected visual acuity (DCVA) at the last follow-up was significantly better than the preoperative DCVA in both groups (SFIOL: 0.52 ± 0.49 vs. 1.20 ± 0.84, [p<0.001], and IFIOL: 0.75 ± 0.88 vs. 1.31 ± 0.81 [p<0.001], respectively [LogMar]). No difference in DCVA was found between the groups. Irregular pupil was found in 59% IFIOL vs. 20.5% of the SFIOL [p<0.001] and corneal edema was found in 10.3% of the IFIOL vs. 1.4% of the SFIOL [p=0.05]. No other differences in intra and post-operative complications were found between the two groups. Conclusion: Both IFIOL and SFIOL are effective and safe for the secure of IOL in the absence of adequate capsular support. Both techniques resulted in a significant improvement in DCVA. Pupil ovalization and corneal edema were more common in the IFIOL group. Longer follow-up was noticed at the IFIOL group.