Comparison of anterior chamber intraocular lens implantation versus four-flanged scleral fixation technique for cases with loss of capsular support during routine cataract surgery

Abstract

Abstract Purpose: To compare the outcomes of anterior chamber intraocular lens (ACIOL) implantation vs the four-flanged scleral fixation technique in eyes with loss of capsular support during routine cataract surgery. Design: A retrospective cohort Participants: All patients in whom IOL was implanted either during or after short-term aphakia due to loss of capsular and sulcus support in a routine cataract surgery with at least 6 months of follow-up time, between 2015to 2023 in a tertiary medical center in Israel. Methods: Two different IOL implantation techniques were compared: the implantation of an angle-supported ACIOL and the four-flanged scleral fixation. Main outcome measures included postoperative complications such as pseudophakic bullous keratopathy (PBK), loss of IOP control and glaucoma, IOL subluxation, retinal detachment. Results: Sixty-five eyes of 65 patients were included in the study. Thirty-three eyes in the ACIOL-group and 32 eyes in the four-flanged group. Follow-up time was 29.92±20.02 months in the ACIOL-group and 20.17±15.56 months in the flange-group (p=0.087). PBK was observed in 10 (30.3%) patients in the ACIOL-group and in one (3.1%) patient in the flange-group (p=0.04). This association remained significant using survival analysis (p=0.006). In four (12.1%) patients in the ACIOL-group a glaucoma filtering procedure was performed to control the pressure compared with none in the flange-group (p=0.049). Conclusion: In the setting of loss of capsular support during routine cataract surgery, four-flanged scleral fixation showed an overall lower rate of complications, including significantly reduced rates of PBK and lower refractive cylinder.