Ab externo 4-point scleral fixation of posterior chamber intraocular lenses

To evaluate the results of ab externo 4-point scleral fixation of posterior chamber intraocular lenses (PC IOLs) as a primary or secondary procedure.

Aravind Eye Hospital, Madurai, India.

This retrospective study comprised 25 patients: 17 aphakic and 8 with traumatic subluxated lenses. The subluxated cataracts were removed intracapsularly. All patients had ab externo 4-point flapless scleral fixation of a PC IOL. Preoperative status, intraoperative details, and postoperative outcome were analyzed.

Mean follow-up was 8.02 months (range 6 to 26 months). The preoperative findings included sector iridectomy (n = 6), peripheral anterior synechias (n = 5), corneal scar (n = 2), vitreous hemorrhage (n = 2), traumatic angle recession (n = 1), retinitis pigmentosa (n = 1), primary open-angle glaucoma (n = 1), and macular pigmentary mottling (n = 1). There were no intraoperative problems related to scleral fixation. Postoperative complications and findings included cystoid macular edema (CME) (n = 2), uveitis (n = 1), and a healed macular choroidal tear (n = 1). No patient had suture exposure, IOL tilt/decentration, or infection. Twenty-two patients (88.0%) had a visual acuity of 6/12 or better at final follow-up. The cause of poor visual recovery in 3 patients included pre-existing macular degeneration, healed macular choroidal tear, and CME in 1 patient each.

Four-point scleral fixation is a simple technique that in this series of 25 patients was not associated with major intraoperative or postoperative complications and gave satisfactory visual results.