Intraocular pressure control after trans-scleral intraocular lens fixation in glaucoma patients

Intraocular lens fixation surgery is associated with fluctuations in intraocular pressure. This may be significantly relevant in glaucoma patients.

To assess short- and medium-term intraocular pressure control after trans-scleral intraocular lens fixation surgery in glaucoma patients.

The charts of all glaucoma patients who underwent trans-scleral intraocular lens fixation surgery with at least 6 months follow-up by a single surgeon between the years 2004 and 2017 were reviewed. Primary outcomes were intraocular pressure at 1 day and 6 months after surgery. Secondary outcome measures were hypotensive medication use and the need for further intraocular pressure lowering interventions.

Eleven eyes of 10 patients were included in the analysis. Mean follow-up post intraocular lens fixation surgery was 54.6 months. Mean intraocular pressure before, 6 months, and last follow-up after intraocular lens fixation surgery was 15.8 ± 5.3 mmHg (range 10.6-25.3), 13.5 ± 3.8 mmHg (range 8-21, p = 0.2), and 11.8 ± 5.6 (range 6-21, p = 0.09) on a mean of 2.3 ± 1.6, 2 ± 1.6 (p = 0.23), and 1.7 ± 1.5 (p = 0.08) hypotensive medications, respectively. A pressure spike was noted in 5 of the 11 eyes on the first post-operative day (mean spike 15.2 mmHg, range 6-23). Four of 11 eyes in the study (36%) needed additional interventions to control intraocular pressure by the 6-month point. One eye required the addition of two classes of topical medications, one eye required laser trabeculoplasty, and two eyes required trabeculectomy.

Over a third of glaucomatous eyes required a change in the management of their disease in the early post-operative period. Close follow-up of patients undergoing trans-scleral intraocular lens fixation surgery is warranted.