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Iris Fixation via External Pentagram Suturing
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Comparative Functional and Morphological Data of Different IOL Dislocation Treatment Methods.
Renata Vaiciuliene1,2, Ugne Rumelaitiene1,2, Martynas Speckauskas1,2
1Department of Ophthalmology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, 44037 Kaunas, Lithuania.
Journal of Clinical Medicine
|March 17, 2025
Summary
Iris fixation offers better visual outcomes and fewer complications for dislocated intraocular lenses (IOLs) compared to anterior chamber IOL (ACIOL) implantation. This minimally invasive technique preserves corneal health and reduces astigmatism, making it a preferred choice.
Area of Science:
- Ophthalmology
- Surgical Techniques
- Intraocular Lens Implantation
Background:
- Late spontaneous dislocation of intraocular lens (IOL)-capsular bag complexes presents a significant clinical challenge.
- Comparing surgical outcomes for these dislocations is crucial for optimizing patient care.
- Tertiary referral centers manage complex cases, necessitating robust comparative data.
Purpose of the Study:
- To compare visual and morphological outcomes of iris fixation (IF) versus anterior chamber intraocular lens (ACIOL) implantation for late dislocated IOL-capsular bag complexes.
- To evaluate the safety and efficacy of IF as a minimally invasive alternative to ACIOL exchange.
- To assess the impact of each technique on visual acuity, corneal health, intraocular pressure, and macular edema.
Main Methods:
- Prospective observational study (2017-2019) involving 83 eyes of 80 patients with late spontaneous IOL-capsular bag dislocation.
- Patients underwent either iris fixation (IF group) or IOL exchange with an ACIOL (ACIOL group).
- Pre- and postoperative assessments included best-corrected distance visual acuity (BCDVA), intraocular pressure (IOP), corneal endothelial cell density (ECD), and macular thickness (for cystoid macular edema [CME]).
Main Results:
- Both groups demonstrated significant BCDVA improvement, with superior results in the IF group (median 0.1 logMAR) compared to the ACIOL group (median 0.3 logMAR; p=0.001).
- Corneal astigmatism remained stable with IF but significantly increased with ACIOL (p<0.001).
- The IF group showed better IOP management, reduced ECD loss (p<0.001), and significantly lower incidence of postoperative CME (4.4% vs 39%; p=0.01).
Conclusions:
- Iris fixation is a safe and minimally invasive technique for managing late dislocated IOL-capsular bag complexes.
- IF provides superior visual outcomes, less induced astigmatism, and fewer postoperative complications compared to ACIOL exchange.
- This approach preserves corneal endothelial cells and reduces the risk of cystoid macular edema.
