Safety and efficacy of current sclera fixation methods for intraocular lenses

Purpose Evaluation of currently three most-common intraocular lens (IOL) sclera fixation techniques (1) Prolene® suture with Hoffman sclera pocket (2) GoreTex® suture four-point technique (3) sutureless flanged intrascleral IOL fixation double-needle (“Yamane”) technique. Study design : Retrospective, clinical case series (chart review) conducted at the Department of Ophthalmology of the Ludwig-Maximilians-University, Munich, Germany. Methods Fifty-seven eyes of 53 patients were included. Best-corrected visual acuity (BCVA), manifest refraction (OR), corneal tomography, biometry, central macular thickness (CMT), intraocular pressure (IOP) were recorded and compared before and at least 20 days after IOL sclera fixation surgery. Results GoreTex® suture was done in 15, Prolene® in 20, Yamane technique in 22 eyes. The GoreTex® group showed 2, Prolene® 3, Yamane 1 eye that needed refixation due to visual impairment. Analysis between pre- and post-surgery revealed a statistically significant difference in the total BCVA (p = 0.002) and the Yamane subgroup BCVA (p = 0.047). There was no statistical difference between pre- and post-surgery IOP, CMT and CCT. No retinal complications were found. Surgery time with Yamane technique was about 1.5 times faster than GoreTex® and Prolene®. The surgery times of the subgroups differed statistical significantly. Regarding safety aspects of the three techniques no statistically significant difference pre- and post-surgery existed. Conclusion A visual rehabilitation to the status pre-surgery seems to be possible with a considerable amount of revision rates. All three analyzed techniques are a successful option in secondary IOL implantation in terms of efficacy and safety. The Yamane technique seems to be the least time-consuming surgical procedure.