Comparison of Clinical Outcomes Among Sutured, Sutureless Scleral Fixation, and Retropupillary Fixation of Intraocular Lens

Purpose: To compare the short-term clinical outcomes (up to 3 months) after three different secondary intraocular lens (IOL) implantations in dislocated and aphakic eyes with insufficient capsular support.Methods: We retrospectively analyzed the medical records of 97 patients who underwent secondary IOL implantation (32 eyes with sutured scleral fixation, 21 with sutureless scleral fixation, and 44 with retropupillary IOL implantation) from March to December 2018. Uncorrected visual acuity (UCVA), and best-corrected visual acuity (BCVA), spherical equivalent (SE), prediction error (PE), mean absolute error (MAE), surgically induced astigmatism (SIA), ocular residual astigmatism (ORA), and complications in the three groups were assessed before and 1 week and 1 and 3 months after surgery.Results: All groups had an improved BCVA beginning 1 month after surgery. The pre- and postoperative SE (p = 0.857, p = 0.263, and p = 0.163) and PE (p = 0.479, p = 0.848, and p = 0.128) did not differ in the sutured scleral fixation, sutureless scleral fixation, and retropupillary IOL implantation groups, respectively; MAE differed significantly among the procedures 1 week after surgery (1.33 ± 1.25, 1.40 ± 1.54, and 0.85 ± 1.25, p = 0.044), but not 1 month after surgery (p = 0.965, p = 0.731). 3 months after surgery, there was no significant difference in SIA (p = 0.140) or ORA (p = 0.178) among the 3 groups. As a complication, intraocular pressure rise occurred more often in the sutured fixated group, while the retropupillary group had a higher dislocation rate.Conclusions: There was no significant difference in the SE, PE, MAE, SIA, ORA, or complications among the three procedures. Surgical skill is still required to minimize the chance of complications regardless of the implantation method.