Autjors: Sun Xincheng, Lu Guohua, Jia Yanwen, Pan Ting, Huang Liqin, Xie Yang
To observe the clinical effect of four-point fixation in patients with posterior chamber intraocular lens dislocation.
A retrospective case series study was adopted.Sixteen patients (16 eyes) with posterior chamber intraocular lens dislocation who underwent suture suspension techniques with four-point fixation in Changzhou No.2 people’s Hospital from January 2015 to January 2018 were enrolled.Postoperative effects were observed during follow-up, ranging from 6 to 13 months.The preoperative and 6-month postoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), corneal endothelium cell count and astigmatism were measured and the differences were compared, and the relationships between total astigmatism and corneal astigmatism or intraocular lens induced astigmatism were analyzed, and the postoperative position of intraocular lens and complications were observed.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Changzhou No.2 People’s Hospital (No.2015-C-012-01).Written informed consent was obtained from each patient before surgery.
The mean preoperative UCVA (LogMAR) and BCVA (LogMAR) were 1.09±0.24 and 0.48±0.20, respectively, which were significantly improved to 0.30±0.12 and 0.26±0.13 at 6 months after operation, respectively.And the differences were statistically significant (t=11.782, 3.795; both at P<0.01).The preoperative and 6-month postoperative corneal endothelium cell count were (2 270±360)/mm2 and (2 032±327)/mm2, respectively, and the difference was not significant (t=1.921, P=0.074).The 6-month postoperative mean total astigmatism, corneal astigmatism and intraocular lens induced astigmatism were (-1.47±0.82)D, (-1.34±0.61)D and (-0.22±0.35)D, respectively.There was a highly positive correlation between total astigmatism and corneal astigmatism (r=0.885, P<0.05), but there was no significant correlation between total astigmatism and intraocular lens induced astigmatism (r=-0.432, P=0.095).No dislocation, deviation or torsion of intraocular lens were observed during the follow-up.Varying degree of symptoms of iridocyclitis were observed during early stage after operation, which disappeared after treatment.There were two cases of high intraocular pressure, which were normal after treatment.No retinal detachment, choroidal detachment, expulsive suprachoroidal hemorrhage, endophthalmitis, corneal endothelial decompensation or other complications occurred during and after operation.
There is a stable position of intraocular lens, good visual acuity and few complications after four-point fixation with suture and suspension, which is a feasible method to treat dislocated intraocular lens.
Four-point intraocular lens suspension in treating intraocular lens dislocation
1.Two straight needles with a double-armed 10/0 prolene suture (Alcon, USA) were punctured into the eye through the upper and lower margin of the 3:00 scleral incision, respectively. The two 25-gauge curved needles were punctured into the eye through the upper and lower margin of the 9:00 scleral incision to guide the two stitching straight needles out of the eyeball respectively.
2.The C-shape haptic of intraocular lens was pulled out through 10:00 transparent corneal incision, and two sutures were knotted on C-shape haptic.
3.The other C-shape haptic of intraocular lens was pulled out through 10:00 transparent corneal incision, and two sutures were knotted on C-shape haptic. The haptic was put into anterior chamber, and the intraocular lens was adjusted to the rear of the iris plane.
4.Four suspended sutures at 3:00 and 9:00 were tightened to center the intraocular lens.