Transscleral suture fixation of posterior-chamber lenses after cataract extraction associated with vitreous loss.

From 1987 to 1993, 21 patients who had undergone complicated cataract extraction that was associated with vitreous loss and transscleral suture fixation of the posterior-chamber lens (PC-IOL) in one eye (group A) and uncomplicated in-the-bag implantation of the PC-IOL in the fellow eye (group B) were followed prospectively. The follow-up period was 29.5 months (SD, +/- 17.0 months) in group A and 36.6 months (+/- 24.0 months) in group B. Visual acuity did not differ significantly between the two groups (P = 0.60, Wilcoxon test). In all, 17/21 patients in group A and 16/21 patients in group B achieved a visual acuity of > or = 20/40. Postoperative refractions measured in group A were +0.68 D more hyperopic than those measured in group B (P < 0.04). This result was consistent with the postoperative finding of a significantly deeper anterior chamber in group A (mean, 0.44 mm; P < 0.03). The accuracy of the desired postoperative refraction was poorer in group A. The risk for retinal detachment, cystoid macular edema, and intraocular pressure elevation was increased in patients who had had capsular defects and vitreous loss during cataract extraction. Nevertheless, transscleral suture fixation of PC-IOLs in patients with complicated cataract extractions associated with vitreous loss can give acceptable visual results. We recommend that +0.5 D be added to the calculated IOL power when severe complications require transscleral suture fixation of the PC-IOL during cataract extraction.