Iris fixation of posterior chamber intraocular lenses☆

Abstract 

Purpose

To describe a technique for suture fixation of silicone intraocular lenses (IOLs) to the iris and compare the outcomes to those in published data.

Setting

Subspecialty cornea/anterior segment private practice, Indianapolis, Indiana, USA.

Methods

This retrospective review comprised 121 consecutive cases of secondary IOL implantation or IOL exchange between 1993 and 1998. All cases had concurrent anterior or posterior vitrectomy. Intraocular lens exchange was performed in 96 eyes, secondary IOL implantation in 20 eyes, and primary IOL implantation in 5 eyes. Penetrating keratoplasty (PKP) was performed concurrently in 93 eyes, extracapsular cataract extraction in 1 eye, intracapsular cataract extraction in 2 eyes, pars plana lensectomy in 2 eyes, and Molteno tube shunt placement for uncontrolled glaucoma in 1 eye. Outcomes measured were graft survival, visual acuity, new onset or worsening of glaucoma, and complications related to surgery.

Results

Graft survival at last follow-up was 89.2% in patients having PKP. Visual acuity was 20/80 or better in 58.3% and 20/40 or better in 30.5% of eyes with transplants. Without transplants, visual acuity was 20/80 or better in 82.0% and 20/40 or better in 57.1%. Glaucoma developed or worsened in 24.7% and improved in 16.1% with transplants; it developed or worsened in 7.0% and improved in 17.8% without transplants. Retinal detachment occurred in 1 eye with a transplant. In the nontransplant group, major complications were bullous keratopathy (n = 2) and tilted IOL (n = 1).

Conclusion

Iris fixation of posterior chamber silicone IOLs may decrease the possibility of late suture breakage and dislocation of the IOL, as well as the risk of endophthalmitis. Graft survival, visual acuity, glaucoma, and complications are similar to those of other methods of IOL fixation reported in the literature.