Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Cheonan Kim's Eye Clinic, Cheonan, Korea.
Korean J Ophthalmol. 2022 Oct;36(5):413-422. doi: 10.3341/kjo.2022.0042. Epub 2022 Aug 19.
To compare the efficacy and safety of conventional scleral fixation (C-SF), retropupillary iris-claw intraocular lens (RP-IOL) implantation, and intrascleral fixation (ISF).
This retrospective observational study included 58 patients (58 eyes) who underwent C-SF (23 eyes), RP-IOL (23 eyes), and ISF (12 eyes) by a single surgeon at Samsung Medical Center from October 2017 to July 2020 and were followed up for at least 6 months. This study analyzed various clinical outcomes before surgery, and 1 day, 1 week, 1 month, 3 months, and 6 months after surgery.
Six months after surgery, best-corrected visual acuity in logarithm of minimum angle of resolution was 0.08 ± 0.10, 0.08 ± 0.16, and 0.03 ± 0.04 in C-SF group, RP-IOL group, and ISF group, respectively, and there was a significant improvement in each group compared to preoperative best-corrected visual acuity. All groups showed a significant increase in astigmatism postoperatively, but no between-group differences were observed. The prediction error was -0.15 ± 0.77, 0.56 ± 0.62, and 0.44 ± 1.00 diopters in the three groups, respectively, indicating RP-IOL group and ISF group for hyperopic shift. The three groups did not differ in terms of absolute prediction error. Six months after surgery, the corneal endothelial cell counts were 2,073 ± 691, 2,014 ± 692, and 1,712 ± 891 cells/mm2, respectively, which were lower than before surgery. IOL dislocation occurred in five eyes only in RP-IOL group, two of which underwent two reoperations, and reenclavation was performed smoothly without complications in all cases.
Although the frequency of IOL dislocation in RP-IOL group was higher than that in the other groups, it can be reenclavated relatively easily. As a method of secondary IOL fixation, both RP-IOL implantation and ISF were as effective as conventional scleral fixation.
比较传统巩膜固定术（C-SF）、后房虹膜夹型人工晶状体（RP-IOL）植入术和巩膜内固定术（ISF）的疗效和安全性。
本回顾性观察研究纳入了 2017 年 10 月至 2020 年 7 月期间在三星医疗中心由同一位外科医生进行 C-SF（23 只眼）、RP-IOL（23 只眼）和 ISF（12 只眼）的 58 例（58 只眼）患者，随访时间至少 6 个月。本研究分析了手术前、手术后 1 天、1 周、1 个月、3 个月和 6 个月的各种临床结果。
术后 6 个月，C-SF 组、RP-IOL 组和 ISF 组最佳矫正视力对数最小角分辨率分别为 0.08±0.10、0.08±0.16 和 0.03±0.04，与术前最佳矫正视力相比均有显著改善。各组术后散光均有显著增加，但组间无差异。三组的预测误差分别为-0.15±0.77、0.56±0.62 和 0.44±1.00 屈光度，提示 RP-IOL 组和 ISF 组为远视漂移。三组在绝对预测误差方面无差异。术后 6 个月，角膜内皮细胞计数分别为 2073±691、2014±692 和 1712±891 个/平方毫米，均低于术前。仅在 RP-IOL 组的 5 只眼中发生了 IOL 脱位，其中 2 只眼进行了 2 次再手术，所有病例均顺利再夹闭，无并发症。
尽管 RP-IOL 组的 IOL 脱位频率高于其他组，但相对容易再夹闭。作为二次 IOL 固定方法，RP-IOL 植入术和 ISF 与传统巩膜固定术同样有效。
