Resumen de Inverted implantation of posterior iris-fixated intraocular lens with 23G transconjunctival vitrectomy in the management of secondary implant. Technique and stability, astigmatism and endothelial loss outcomes
José Ramón Anglada Escalona, Jordi Castellví Manent, M. Ángeles Parera Arranz, A. Sabala Llopart
PURPOSE: To study outcomes and complications and evaluate the safety and efficacy of 23-gauge transconjunctival sutureless vitrectomy (23G PPV) to remove vitreous adhesions of dislocated or subluxated lens and in aphakia, combined with inverted implantation of posterior Artisan® iris-fixated intraocular lens.
SETTING: Ophthalmology Unit. Hospital Universitari Germans Trias i Pujol, Spain.
METHODS: 23G PPV was combined with iris-claw implantation and incision in the steepest meridian in 32 patients. Patients were followed-up for one year.
RESULTS: Complications: one bleeding in an acenocoumarol user, one intraoperative dislocation, one accidental iridotomy, five postoperative subluxations. No complications such as cystoid macular edema, retinal detachment or choroid were recorded. Refraction was measured after a mean of 59.9 days. The corrected distance visual acuity (CDVA) was 0.17 ± 0.33 logMAR (0.67 ± 0.27) and, when the six patients with poor prognosis were excluded from the group, CDVA was 0.10 ± 0.06 logMAR (0.79 ± 0.11). Visual acuity of over 0.5 was achieved in 81.25% of all patients. Spherical equivalent was 0.07 ± 0.59, and 87.1% were within the range of ± 1 D. Astigmatism by subtraction was 0.69 ± 0.93 D, and by vector 1.35 ± 0.57 D. There were no differences regarding incision location (p = 0.941) or the eye involved (p = 0.563). The mean endothelial cell density at baseline was 1546 ± 422 cells/mm2 and the final value was 1322 ± 360 cells/mm2 . Total cell loss was 13.6%, in aphakia 6.2%, in replacement 11.8%, in subluxated lens 12.6%, in dislocated lens 19.7%. Only 25% of the lenses would have been further than 3 mm from the endothelium if the implant had been anterior.
CONCLUSION: This combined technique is safe, effective and predictable. Its major complication is early haptic dislocation, which is simple to resolve. The 23G PPV provides excellent treatment of the posterior cavity and prevents further complications.
