Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel.
Department of Ophthalmology, E. Wolfson Medical Center, Holon, Israel.
Can J Ophthalmol. 2024 Dec;59(6):e653-e660. doi: 10.1016/j.jcjo.2024.03.014. Epub 2024 Apr 15.
To compare the outcome of 2 intraocular lens (IOL) scleral fixation techniques: double-flanged polypropylene and Hoffman scleral pocket.
Retrospective case series of all patients who underwent IOL scleral fixation by either the flange (flange group) or Hoffman scleral pocket (Hoffman group) techniques at the Kaplan Medical Center and the Edith Wolfson Medical Center.
A total of 140 patients were included (63 flange, 77 Hoffman). The final distance-corrected visual acuity was similar between the flange and Hoffman groups (0.42 ± 0.5 and 0.51 ± 0.5 logMAR, respectively; p = 0.23), but the spherical equivalent was less myopic in the flange group (-0.63 ± 2 and -2.3 ± 1.3 D, respectively; p = 0.003). In the flange group, there were more cases of elevated IOP (17.5% vs 5.2%; p = 0.02), corneal edema (11.1% vs 1.3%; p = 0.02), cystoid macular edema (15.9% vs 2.6%; p = 0.005), and IOL decentration (19% vs 7.8%; p = 0.07). The flange group had a higher rate of combined additional procedures during the fixation surgery (68.3% vs 32%; p < 0.001), but surgery duration was not prolonged (70 vs 77 minutes; p = 0.29).
Comparison of scleral IOL fixations performed with the recently developed flange technique to the conventional Hoffman scleral pocket technique resulted in similar visual outcomes and less myopization. There were more complications in the newly adopted flange technique, which may be related to the higher rate of combined anterior vitrectomy and pars plana vitrectomy. The flange technique is effective, with a shorter learning curve and similar surgical time. Therefore, it can become a viable method for scleral IOL fixation in the absence of zonular support.
比较两种巩膜固定人工晶状体（IOL）的手术效果：双凸缘聚丙烯和 Hoffman 巩膜口袋。
回顾性病例系列研究，所有在 Kaplan 医疗中心和 Edith Wolfson 医疗中心接受 IOL 巩膜固定术的患者，分别采用凸缘（凸缘组）或 Hoffman 巩膜口袋（Hoffman 组）技术。
共纳入 140 例患者（凸缘组 63 例，Hoffman 组 77 例）。凸缘组和 Hoffman 组的最终距离校正视力相似（分别为 0.42±0.5 和 0.51±0.5 logMAR；p=0.23），但凸缘组的等效球镜度数更近视（-0.63±2 和-2.3±1.3 D；p=0.003）。在凸缘组中，眼压升高（17.5%比 5.2%；p=0.02）、角膜水肿（11.1%比 1.3%；p=0.02）、囊样黄斑水肿（15.9%比 2.6%；p=0.005）和 IOL 偏心（19%比 7.8%；p=0.07）的发生率更高。凸缘组在固定手术中联合进行其他附加手术的比例更高（68.3%比 32%；p<0.001），但手术时间并未延长（70 分钟比 77 分钟；p=0.29）。
与传统的 Hoffman 巩膜口袋技术相比，最近开发的凸缘技术进行巩膜 IOL 固定的结果相似，近视化程度更低。新采用的凸缘技术并发症更多，这可能与联合前玻璃体切除术和睫状体平坦部玻璃体切除术的比例较高有关。凸缘技术有效，学习曲线更短，手术时间相似。因此，在没有后囊支持的情况下，它可以成为巩膜 IOL 固定的一种可行方法。
