Suture-less flanged IOL fixation vs. conventional sutured SF in IOL dislocation
Reviewed by Sofia Rokerya

The authors report the analysis of a prospective, comparative cohort study on 103 consecutive patients (103 eyes) with intraocular lens (IOL) dislocation who underwent vitrectomy with IOL removal and sutured scleral fixation (SF) (53 eyes) or flanged IOL fixation (50 eyes). The onset of IOL dislocation occurred 86.6 ±27.9 months (range 36-180 months) after the previous cataract surgery in the sutured SF group and 87.8 ±36.0 months (range 37-204 months) after in the flanged IOL fixation group. Three-piece IOL (Acrysof MN60AC) was used in the SF group and Sensar AR40e was used for the flanged IOL fixation group. The two groups did not differ significantly in age or sex distribution, baseline best-corrected visual acuity (BCVA), intraocular pressure (IOP), axial length or the timing of the onset of IOL dislocation after the previous cataract surgery (p>0.05, respectively). The operating time for SF was significantly different, with a shorter time for flanged IOL fixation (19.4 ±4.6 min [range 12.5-28.0 min] vs. 48.9 ±5.2 min [range 41.5-66.0 min] for sutured SF) (p<0.001). Compared with baseline, the BCVA at 12 months was significantly improved: 0.18 ±0.11 (Snellen 20/30, p<0.001) in the sutured SF group and 0.17 ±0.09 (Snellen 20/30, p<0.001) in the flanged IOL fixation group. Furthermore, the BCVA in both groups improved significantly at one, three and six months postoperatively (p<0.001 at all three time points for sutured SF; p=0.001, p<0.001, and p<0.001, respectively, for flanged IOL fixation). However, there was no significant difference in BCVA between the groups at all three time points (p>0.05). There was no significant change in refractive difference between the groups (p=0.617). There was also no significant change in horizontal, vertical or total decentration between the groups (p>0.05). Early complications, i.e. one-month post-op (vitreous haemorrhage, hypotony and IOP elevation; p>0.05) did not differ between the sutured SF and flanged IOL fixation groups. Late complications, i.e. between one month to 12 months (cystoid macular oedema and IOP elevation; p>0.05) also did not differ between the two groups. The long-term viability of 10-0 polypropylene sutures is of particular concern in patients with sutured SF for IOL dislocation. This study demonstrated that suture-less flanged IOL fixation had similar clinical outcomes and IOL stability to sutured SF within 12 months postoperatively. However, the operating time for the flanged IOL fixation was less than half that of the sutured SF, making this technique an efficient alternative option to treat patients with dislocated IOL. Limitations include small sample size, lack of randomisation and no monitoring reported for post-op follow-up after one year. Also, patients with sutured SF underwent 23G vitrectomy and those with flanged IOL fixation underwent 25G vitrectomy. The two different techniques used might have affected the post-op outcome. Strength: All surgeries were performed by the same retinal surgeon.

A 1-year prospective comparative study of sutureless flanged intraocular lens fixation and conventional sutured scleral fixation in intraocular lens dislocation.
Do JR, Parka SJ, Mukaic R, et al.
OPHTHALMOLOGICA
2021;244:68-75.