Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, Republic of Korea.
Graefes Arch Clin Exp Ophthalmol. 2022 Oct;260(10):3267-3273. doi: 10.1007/s00417-022-05692-9. Epub 2022 May 19.
This study aimed to investigate the clinical characteristics of patients with recurrent intraocular lens (IOL) dislocation after scleral-fixated sutured IOL implantation and evaluate the long-term outcomes of scleral re-fixation of IOL.
The medical records of patients who underwent surgery for IOL dislocation between January 2011 and January 2021 were reviewed. The study included 164 patients (male: 131, female: 33) (176 eyes). Patient demographics, preoperative, intraoperative and postoperative data, and the ocular and systemic conditions associated with IOL re-dislocation were analyzed.
The study included 176 consecutive cases of scleral-fixated sutured IOL. Twenty-six eyes (14.8%) showed re-dislocation of IOL after the initial IOL scleral fixation and underwent reoperation (mean 75.5 ± 62.5 months after the first surgery); three (11.5%) of them required a third surgery. Younger adults (aged less than 40 years), and patients who underwent IOL scleral fixation in complicated cataract surgery or aphakic state had a higher risk of re-dislocation. Diabetes mellitus (DM) was the only statistically significantly higher risk factor in the re-dislocated group (p = 0.041). The complication rate with scleral re-fixation was higher than that in the non-re-dislocated group. No statistically significant differences were observed, except for vitreous hemorrhage (p = 0.024).
Caution should be exercised when performing sutured scleral fixation of IOL in younger patients, cases of complicated cataract surgery and aphakia, and patients with DM to prevent IOL re-dislocation. Scleral-fixated sutured IOL in eyes with recurrent IOL dislocation seems to be a safe and effective procedure with a relatively low complication rate.
本研究旨在探讨巩膜缝线固定术后复发性人工晶状体（IOL）脱位患者的临床特征，并评估 IOL 巩膜再固定的长期效果。
回顾 2011 年 1 月至 2021 年 1 月期间因 IOL 脱位而接受手术的患者的病历。本研究纳入了 164 名患者（男：131 名，女：33 名）（176 只眼）。分析了患者的人口统计学、术前、术中及术后资料，以及与 IOL 再脱位相关的眼部和全身情况。
本研究共纳入 176 例连续的巩膜缝线固定 IOL 手术。26 只眼（14.8%）在初次 IOL 巩膜固定后出现 IOL 复发性脱位，并进行了再次手术（第一次手术后平均 75.5±62.5 个月）；其中 3 只眼（11.5%）需要第三次手术。年轻患者（年龄小于 40 岁）和在复杂白内障手术或无晶状体状态下接受 IOL 巩膜固定的患者，其 IOL 再脱位的风险更高。糖尿病（DM）是再脱位组中唯一具有统计学显著意义的更高风险因素（p=0.041）。巩膜再固定组的并发症发生率高于未再脱位组，但除玻璃体积血（p=0.024）外，其他差异无统计学意义。
在对年轻患者、复杂白内障手术和无晶状体患者以及 DM 患者进行巩膜缝线固定 IOL 时应谨慎，以防止 IOL 再脱位。对于复发性 IOL 脱位的眼睛，巩膜缝线固定 IOL 似乎是一种安全有效的方法，其并发症发生率相对较低。
