“OUR EXPERIENCE OF SECONDARY IOLS - SCLERAL FIXATION v/sAC IOL DR. RUPAM DESAI ROTARY EYE INSTITUTE NAVSARI INDIA (Author has no financial interest)

INTRODUCTION When we think about aphakic eyes, it is a complication – comes to our mind immediately. Scleral fixation IOL is really boon to aphakic patients who have no posterior capsule. So, patient can really enjoy a good pseudophakic vision without any corneal complications as which may be induced by AC IOLs.

Materials & Methods It was a prospective study of 40 eyes. Group A -22 eyes, underwent Scleral fixation IOL procedure. Group B includes 18 eyes, underwent AC IOL implantation. Patients demographic data shows mean age of 62 with M:F ratio is 32:8. Systemic ailments were ruled out.

Materials & Methods Primary cause of surgery was senile cataract in 34 patients, subluxated cataract in 4 patients, traumatic cataract in 2 patients. The duration between primary and secondary surgery was between 3 months to 2 years. Preoperative vision, IOP, corneal thickness, specular microscopy, gonioscopy, SLE and fundus examination was done in all patients.

Surgical Procedure P/B anesthesia was given. Complete aseptic precaution was taken. Conjunctival peritomy done. Cauterization done. Scleral tunnel made for IOL insertion. 2 scleral pockets made 180 º apart (avoiding 3 and 9 o’clock). Vitrectomy was done if required.

Surgical Procedure Scleral fixation suture (10-0 prolene with straight needle) passed from 1 scleral pocket to opposite scleral pocket. Suture was pulled out through superior tunnel and suture was cut. Cut ends were tied with holes of haptics of IOL. Other end of suture was pulled and IOL was inserted in posterior chamber. Straight needle of suture was then passed through sclera and tied.

Surgical Procedure Scleral pockets were sutured with 10-0 nylon. Conjunctival sutures taken. S/C antibiotics and steroids given. Postoperatively oral antibiotics, topical antibiotics, steroids and cyclopegics were given. All patients were followed up on 1st day, week, 1 month, 3month, 6month and year. At each follow up patients were evaluated in detail.

Results Group – AGroup – B Visual improvement51.54 %33.33 % Visual deterioration18.18%44.44% Hypotony_2.22% CME9%22.22% IOL decentration_11.11% AC reaction27%33.33% Stitch granuloma0.1%_ Mean astigmatism2.35D1.25D

Discussion Our prospective study shows that visual outcome and complications were comparable and few in both groups. Hill et all showed that 44.4 % had improved BCVA as compared to 54.54% of our study. Lee et all (1993) revealed that Scleral fixation may cause greater degree of tilt as compared to routine PC IOL, the tilt has little effect on post operative astigmatism. In our study mean astigmatism is 2.5 D which may be due to large incision and sutures and none of the patient show tilt of IOL.

Discussion AC reaction and CME may be due to vitrectomy. Suture erosion was reported by Solomon, Heilskov, Othoff. Endophthalmitis was reported in cases with exposed sutures. In our study there is no endophthalmitis and only 1 case shows suture exposure. Ab externo approach reduces the chances of vitreous hemorrhage as compared to Ab interno approach practiced by Uthoff.

Conclusion What ever is the cause of aphakia, proper preoperative evaluation, good intra operative vitrectomy followed by SF IOL implantation give good postoperative comfort and better alternative to AC IOL.

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