Eyeworld

JULY 2021 | EYEWORLD | 19 References 1. Zeh WG, Price Jr FW. Iris fixation of posterior chamber intraocular lenses. J Cataract Refract Surg. 2000;26:1028–1034. 2. Bleckmann H, Kaczmarek U. Functional results of posterior chamber lens implantation with scleral fixation. J Cataract Refract Surg. 1994;20:321–326. 3. Koh HJ, et al. Scleral fixation technique using 2 corneal tun- nels for a dislocated intraocular lens. J Cataract Refract Surg. 2000;26:1439–1441. 4. OH H-S, et al. Surgical technique for suture fixation of a single-piece hydrophilic acrylic intraocular lens in the absence of capsule support. J Cataract Refract Surg. 2007;33:962–965. 5. Agarwal A, et al. Fibrin glue-assisted sutureless posteri- or chamber intraocular lens im- plantation in eyes with deficient posterior capsules. J Cataract Refract Surg. 2008;34:1433–1438. 6. Maggi R, Maggi C. Sutureless scleral fixation of intraocular lenses. J Cataract Refract Surg. 1997;23:1289–1294. 7. Gabor SGB, Pavlidis MM. Sutureless intrascleral poste- rior chamber intraocular lens fixation. J Cataract Refract Surg. 2007;33:1851–1854. 8. Kumar DA, et al. Glued intrascleral fixation of posterior chamber intraocular lens in children. Am J Ophthalmol. 2012;153:594–601. that overall, the glued IOL technique has a good long-term safety profile. There are some considerations that should be made when using the glued IOL technique. The technique requires dissection of scleral flaps with a conjunctival cutdown, so it is not ideal in patients with conjunctival scarring, history of previous glaucoma surgeries, or history of vitreoretinal surgeries including scleral buckles. Additionally, the technique should be used with caution in eyes with compromised scleral integ- rity as sclerotomies are necessary to externalize the haptics. Patients with a history of uveitis have been shown to have higher incidence of cystoid macular edema and a longer time to res- olution of anterior chamber inflammation com- pared to non-uveitic eyes undergoing the glued IOL technique. 13 In short eyes, patients may be more likely to have haptic extrusion, resulting in a posteriorly positioned optic. On the other hand, in myopic eyes, it may be more difficult to perform the scleral tuck of the haptics given the larger limbus size. When comparing outcomes of the glued IOL technique to the Yamane technique, 14 IOL tilt in the glued IOL technique was reported to be less (0.8±1.7 degrees in the 90 to 270 residual astigmatism was 1.1 D as determined using the Alpins method of vector analysis. Loss of corrected distance visual acuity was attribut- ed to retinal detachment (n=2), traumatic optic neuropathy (n=1), and corneal decompensation (n=2). The mean postoperative intraocular pressure was significantly higher compared to preoperative IOP (p=0.001), and 10 eyes had an IOP of greater than 21 mm Hg, seven of which were diagnosed with glaucoma. One eye was documented to have uveitis-glaucoma-hy- phema syndrome. Additional complications noted in the postoperative period included corneal endo- thelial decompensation (n=3) at 5.3±3.5 years, cystoid macular edema (n=4), retinal detachment (n=3) at 2.6 years from surgery, and haptic subluxation (n=4) at 8±1.6 years postoperatively. In this cohort, secondary sur- geries included penetrating keratoplasty (n=1), trabeculectomy (n=1), glaucoma drainage device insertion (n=1), haptic repositioning (n=3), IOL explantation (n=1), pupilloplasty (n=2), and retinal detachment repair (n=3). No eyes developed IOL dislocation, choroidal detachment, or endophthalmitis. Discussion It is imperative to have several techniques in one's surgical repertoire to manage complex eyes with deficient capsules. Common indica- tions for this technique include intraoperative posterior capsule rupture, subluxated cataract or IOL, aphakia, and ectopia lentis with deficient zonular fibers. 11 When comparing the glued IOL technique to primary AC IOLs, transscleral fixated sutured IOLs, and iris claw IOLs, the au- thors reported less incidence of endothelial cell damage, retinal detachments, glaucoma, uveitis, macular edema, suture degradation, and IOL tilt 12 and overall better outcomes. 11,12 There is limited long-term data on current scleral fixated lens techniques, therefore this publication not only provides necessary data but is reassuring continued on page 20 "The authors presented long-term results of the glued IOL technique that overall had good anatomical and functional outcomes showing stability in these complex patients."

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