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EW CATARACT 90 April 2017 by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer IOP of 15 mm Hg ± 7 mm Hg (P = .192). There were no intraoperative complications regarding IOL stabil- ity, centration, or haptic integrity, corroborating the findings of a previous research team that com- pared surgeries using sutured and glued scleral-fixated IOLs. 1 The study achieved similar visual outcomes 6 months after surgery in 25 sutured and 25 glued-IOL eyes but found that glued IOLs were associated with fewer complications than sutured eyes. In this study, postoperative complications were not dramatic and could be managed. The GIOL group revealed two cases of hypoto- ny that self-resolved, one case of oc- ular hypertension that resolved with timolol, which was slowly tapered off; one case of PBK that required Descemet's stripping automated en- dothelial keratoplasty (DSAEK), and one case of lens prolapse requiring surgical repositioning. The SSIOL group revealed one case of cystoid macular edema, one case of PBK requiring DSAEK, and one case of superior rhegematous retinal detach- ment (RRD), whereby the investiga- tors could not be sure whether the RRD was related to the surgery. Similar findings Findings from previous work on the subject that reviewed 735 eyes with GIOLs showed that the use of GIOLs and its surgical modifications had good visual outcomes with minimal complications, much like those of the present study. 2 Although the study results were associated with certain IOL optic-related complica- tions like optic capture and decen- tration, and haptic-related compli- cations that were mostly related to improper scleral tucking like haptic extrusion, haptic dislodgement, broken haptic, and subconjunctival haptic, they were minimal. The sur- gical modifications included glued Why choosing between scleral sutured and glued IOLs is becoming easier T he choice between scler- al-sutured IOLs (SSIOL) and glued IOLs (GIOL) for use in eyes with inadequate capsular support may now be an easier one to make, thanks to evolving techniques and improved IOL designs. Still, the implantation of GIOLs for secondary or replace- ment IOL surgery is a relatively new procedure, with its own set of surgi- cal challenges, about which there is still some debate. In a retrospective review of 113 secondary IOL or IOL exchange sur- geries performed since 2012 by two cornea surgeons at the University of Michigan, W.K. Kellogg Eye Center, Ann Arbor, the operating surgeons, Shahzad Mian, MD, and Jonathan Greene, MD, experienced no intra- operative complications, and they achieved mean postoperative SSIOL and GIOL visual acuities that were not significantly different between the two techniques/IOLs, according to lead author Jose Davila, research assistant, University of Michigan, Department of Ophthalmology and Visual Sciences, who presented the study poster at the American Acade- my of Ophthalmology 2016 annual meeting in Chicago. Review The review identified 16 SSIOL cases and 17 GIOL cases among the 113 secondary IOL or IOL exchange surgeries that were documented at the Kellogg Eye Center since 2013. The SSIOL cases were comprised of 10 male and six female patients, and the GIOL cases were 13 male and four female patients. Their mean ages were 59 years ± 20 years for SSIOL and 66 years ± 14 years for GIOL cases (P = .308). The mean time between the operation and the postoperative visit was 40 days ± 18 days in SSIOL cases and 39 days ± 18 days in GIOL cases (P = .800). Right eye surgery was performed in nine SSIOL patients and in 10 GIOL pa- tients. P-values were calculated using a two-sided T-test that compared the postoperative SSIOL to postoperative GIOL outcomes. Patients who underwent sec- ondary IOL surgery or IOL exchange had similar preoperative indications. Of the preoperative diagnoses for GIOL, 59% were associated with lens dislocation, and 41% were related to aphakia. Lens dislocation was the predominant preoperative diagnosis in 69% of SSIOL cases, followed by aphakia in 25%, and 6% attributed to other causes, such as pseudopha- kic bullous keratopathy (PBK) with chronic inflammation, which was likely to have developed secondary to previous IOL positioning. The investigation compared the preoperative and postoperative best corrected visual acuities (BCVA) and IOPs among the two IOL groups. The mean BCVA was 20/211 (or logMAR 1.0 ± 0.8) (P = .282) in GIOL eyes before surgery and 20/ 90 (or logMAR 0.6 ± 0.5) (P = .282) after surgery. The mean BCVA in the SSIOL eyes was 20/118 (or logMAR 0.7 ± 0.6) before surgery and 20/58 (or logMAR 0.5 ± 0.5) (P = .282) after surgery. Pressures before and after IOL surgery were in a similar range in the IOL groups. In the GIOL group, the mean IOP was 15 mm Hg ± 7 mm Hg preoperatively and 16 mm Hg ± 7 mm Hg, postoperatively (P = .192). The SSIOL group had a mean preoperative IOP of 17 mm Hg ± 8 mm Hg and a mean postoperative Glued versus scleral sutured: Take your pick Preoperative diagnoses of patients with SSIOL and GIOL. Pseudophakic bullous keratopathy with chronic inflammation, likely secondary to previous IOL positioning. Source: Jose Davila continued on page 92 Presentation spotlight

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