Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona.
Stein Eye Institute, University of California, Los Angeles, Los Angeles, California.
Ophthalmology. 2020 Sep;127(9):1234-1258. doi: 10.1016/j.ophtha.2020.03.005. Epub 2020 Jun 5.
To review the published literature on the visual acuity results and complications of different surgical techniques for intraocular lens (IOL) implantation in the absence of zonular support.
Peer-reviewed literature searches were conducted last in PubMed and the Cochrane Library in July 2019. The searches yielded 734 citations of articles published in English. The panel reviewed the abstracts of these mostly retrospective case series studies, and 45 were determined to be relevant to the assessment objectives. Three articles were rated as level II evidence, and 42 articles were rated as level III evidence.
Eight different types of IOL fixation techniques with at least 6-month follow-up were evaluated: anterior chamber IOL (ACIOL), iris-claw IOL, retropupillary iris-claw IOL, 10-0 polypropylene iris-sutured posterior chamber IOL (PCIOL), 10-0 polypropylene scleral-sutured PCIOL, 8-0 polypropylene scleral-sutured PCIOL, CV-8 polytetrafluoroethylene, and intrascleral haptic fixation (ISHF). Eight articles reported data comparing 2 techniques. The 45 studies had insufficient statistical power to compare the techniques conclusively. A qualitative analysis of similar types showed that trends in visual acuity outcomes were not inferior to those of ACIOL implantation, but the severity of preoperative pathologic features was not controlled for. Compared with ACIOL, complications of cystoid macular edema were higher in 10-0 polypropylene iris-sutured PCIOL and 8-0 polypropylene scleral-sutured PCIOL. Non-anterior chamber IOL techniques were less likely to report chronic uveitis. Chronic glaucoma was highest in the 8-0 polypropylene scleral-sutured PCIOL group. Although retinal detachment was infrequent overall, it was twice as common in both iris- and scleral-sutured PCIOLs (except CV-8 polytetrafluoroethylene suture) compared with nonsutured methods: ACIOL, iris-clipped IOL, and ISHF PCIOL.
The evidence reviewed shows no superiority of any single IOL implantation technique in the absence of zonular support. The various techniques seem to have equivalent visual acuity outcomes and safety profiles. Each technique has its own profile of inherent risk of postoperative complications. Surgeons must educate patients on the importance of close, long-term follow-up as a result of the uncertain nature of these techniques. Large prospective studies are needed to confirm the long-term complication profiles of these various IOL implantation techniques.
回顾在缺乏悬韧带支持的情况下，不同人工晶状体（IOL）植入术式的视力结果和并发症的已发表文献。
研究人员于 2019 年 7 月在 PubMed 和 Cochrane 图书馆进行了同行评审文献检索。检索得到了 734 篇发表于英文期刊的文章。专家组审查了这些主要回顾性病例系列研究的摘要，其中 45 篇被认为与评估目标相关。有 3 篇文章被评为二级证据，42 篇文章被评为三级证据。
评估了至少 6 个月随访的 8 种不同类型的 IOL 固定技术：前房人工晶状体（ACIOL）、虹膜夹人工晶状体、后房虹膜夹人工晶状体、10-0 聚丙烯虹膜缝线后房人工晶状体（PCIOL）、10-0 聚丙烯巩膜缝线 PCIOL、8-0 聚丙烯巩膜缝线 PCIOL、CV-8 聚四氟乙烯和巩膜缝线固定术（ISHF）。有 8 篇文章报告了比较 2 种技术的数据。这 45 项研究的统计效力不足以明确比较这些技术。对相似类型的定性分析表明，视力结果的趋势并不逊于 ACIOL 植入术，但未对术前病理性特征的严重程度进行控制。与 ACIOL 相比，10-0 聚丙烯虹膜缝线 PCIOL 和 8-0 聚丙烯巩膜缝线 PCIOL 中更易发生囊样黄斑水肿并发症。非前房人工晶状体技术较少报告慢性葡萄膜炎。8-0 聚丙烯巩膜缝线 PCIOL 组慢性青光眼发生率最高。虽然总体上视网膜脱离并不常见，但与非缝线方法（除 CV-8 聚四氟乙烯缝线外）相比，虹膜和巩膜缝线 PCIOL （ACIOL、虹膜夹人工晶状体和 ISHF PCIOL）的发生率均为其两倍。
回顾的证据表明，在缺乏悬韧带支持的情况下，任何单一的 IOL 植入技术都没有优势。各种技术似乎具有相当的视力结果和安全性。每种技术都有其自身固有的术后并发症风险特征。由于这些技术的性质不确定，外科医生必须告知患者密切、长期随访的重要性。需要进行大型前瞻性研究来证实这些不同的 IOL 植入技术的长期并发症情况。
