Comparison of Outcomes of Anterior Chamber Intraocular Lenses with Scleral-fixated Intraocular Lenses: A Systematic Review

The absence of adequate posterior capsule support—whether due to complicated cataract surgery, lens subluxation due to trauma or syndromes, or aphakia due to any other cause—necessitates a suitable intraocular lens (IOL), either an anterior chamber intraocular lens (ACIOL) or a scleral-fixated IOL. The absence of any systematic review in the English literature comparing ACIOL with scleral-fixated IOL prompted this study. We looked for clinical trials (randomized and controlled) comparing the outcomes of ACIOL with scleral-fixated IOLs through various search engines. The searched terms included anterior chamber intraocular lens, scleral-fixated intraocular lens, complicated cataract surgery, and secondary intraocular lens. All patients who had either an ACIOL or scleralfixated IOL were included. Risk of bias was assessed using the Cochrane Collaboration tools to ascertain the standard and quality of the trials. The outcomes studied were best-corrected visual acuity (BCVA) and intraoperative and postoperative complications. Seven trials were finally selected for analysis. There was no difference in BCVA between ACIOL and scleral-fixated IOL. There was also no difference in terms of complications, including retinal detachment, cystoid macular edema, glaucoma, uveitis, and vitreous prolapse, between the two groups. However, there was a higher chance of vitreous hemorrhage in the scleral-fixated group compared to ACIOL. Both ACIOL and scleralfixated IOLs appear to be used as safe options in current practice. Further multicenter randomized controlled trials are needed to clarify the benefits of each intervention and strengthen the validity of this review