Trans-scleral Fixation of Posterior Chamber Intraocular Lens Combined with Vitreoretinal Surgery

Purpose: To report the outcomes of trans-scleral fixation of posterior chamber intraocularlens (PCIOL) combined with complete vitrectomy and prophylactic band placement.Methods: Hospital records of 18 patients who underwent the procedure were reviewed.Indications for vitreoretinal surgery included previous penetrating ocular trauma,complicated cataract surgery and vitreous incarceration, and chronic cystoid macularedema. All patients had iris and angle damage with inadequate lens capsular support.Age, sex, surgical technique, follow up duration and pre- and postoperative bestcorrected visual acuity (BCVA) were evaluated.Results: Overall 18 eyes of 18 patients (14 men and 4 women) with mean age of 34.8±23(range 5-76) years were operated. Mean follow up duration was 36±32.4 (range 6-96)months. Of the 18 operated eyes 7 were aphakic, 6 had complete IOL dislocation into thevitreous cavity, 4 had subluxated cataractous lens and one had a subluxated IOL. Thenumber of eyes with BCVA≥20/40 increased from 3 (16.7%) preoperatively to 9 (50%)postoperatively (P 0.01). Postoperative complications were encountered in 9 eyes andincluded uveitis, vitreous hemorrhage, repeat IOL dislocation and retinal detachment.Conclusion: In the absence of adequate capsular support, trans-scleral fixation of aPCIOL combined with vitreoretinal surgery seems to be effective for visual rehabilitationin selected patients with complicated cataracts or previous cataract surgery. Applicationof this technique in children deserves caution. Larger studies and a randomizedclinical trial with long-term follow up are required to confirm these results.