27-gauge microincision vitrectomy surgery-assisted scleral fixation of intraocular lens: An anterior segment optical coherence tomography-guided study

Purpose: To evaluate the outcomes of 27-gauge (27G) microincision vitrectomy surgery (MIVS)-assisted scleral fixation of intraocular lenses (SFIOLs) using anterior segment optical coherence tomography (AS-OCT). The study assesses postoperative intraocular lens (IOL) tilt, decentration, and iris to IOL distance and their impact on visual and refractive outcomes. Methods: This retrospective study included 36 patients undergoing 27G MIVS-assisted SFIOL implantation. Preoperative data, including best-corrected visual acuity (BCVA), intraocular pressure (IOP), endothelial cell count, and surgical indications, were recorded. Postoperatively, BCVA, IOP, and endothelial cell count were assessed at 3 months. Additionally, postoperative AS-OCT was performed to assess IOL tilt, decentration, and distance of the IOL from the posterior iris surface. Surgical complications were documented. Results: The mean IOL tilt was 3.58 ± 0.57 degrees, IOL decentration was 0.22 ± 0.47 mm, and IOL to posterior iris distance was 0.76 ± 0.66 mm. At three months, BCVA significantly improved from 0.85 ± 0.53 log MAR to 0.38 ± 0.38 log MAR ( P = 0.03). Hyperopic shift (manifest refractive spherical equivalent [MRSE]: +1.14 ± 0.62 D) correlated strongly with increased distance of IOL from the posterior iris surface. Complications included early postoperative IOL tilt ( n = 4, requiring refixation), vitreous hemorrhage ( n = 3, resolving spontaneously), and choroidal detachment ( n = 2, resolving with corticosteroids). Conclusions: The 27G MIVS-assisted SFIOL technique demonstrates favorable outcomes with minimal IOL tilt and decentration. The technique offers a safe and effective alternative for scleral fixation, optimizing surgical efficiency and patient outcomes.