Postoperative complication rates in intraocular lens placement and fixation methods for inadequate capsular bag...

To evaluate the complication rates of different intraocular lens (IOL) placement methods in adults with inadequate capsular bag support.

The surgical correction of inadequate capsular bag support for the IOL harbors several challenges, and there is a wide range of surgical procedures.

For the purpose of this meta-analysis, surgical methods were grouped based on the location of IOL placement: (1) anterior chamber (AC) placement; (2) iris fixation, which included prepupillary or retropupillary placement of an iris-claw IOL, or iris suturing of an IOL; and (3) scleral fixation, which included scleral sutured and sutureless techniques. Only studies comparing the results of 2 or more different placement methods were analyzed. The study protocol has been registered in the PROSPERO database (CRD42023458557).

15 studies were included in the final analysis, which reported results of 1247 eyes. The overall complication rate was nonsignificantly lower in iris fixation (4.4%; 95% CI, 3.6%-5.4%, P = .150) than in AC placement (7.4%; 95% CI, 6.4%-7.9%) and scleral fixation (7.4%; 95% CI, 6.5%-8.4%). Transient corneal edema was the most common complication in AC placement (29.9%; 95% CI, 2.4%-57.5%, P < .001), compared with scleral fixation (11.9%; 95% CI, 2.6%-21.2%) and iris fixation (4.1%; 95% CI, 0.8%-7.3%). Vitreous hemorrhages were more frequently reported after scleral fixation (8.5%; 95% CI, 6.3%-11.2%, P = .006) than in AC placement (5.4%; 95% CI, 3.4%-8.5%) and iris fixation (1.4%; 95% CI, 0.4%-4.2%), and so was IOL decentration/dislocation (8.9%; 95% CI, 6.7%-11.8%, P = .047 compared with 1.1%; 95% CI, 0.4%-3.4% and 4.0%; 95% CI, 2.2%-7.3%, respectively).

The risks associated with particular techniques should be taken into account in preoperative counseling and planning postoperative treatment.