This cross-sectional, retrospective cohort study was performed using15 eyes of 15 patients who underwent the SISFIOL technique, and 14 eyes of 14 patients who underwent the IFIOL technique for the dislocated PCIOLs from 2017 to 2021 with a minimum of 9 months-follow‑up were included in the study at Izmir Katip Celebi University, Ataturk Training and Research Hospital Eye Clinic. Patients were excluded if they underwent surgery at less than 18 years of age, the follow-up the period was less than six months, corneal scar glaucoma, macular scar. The study was performed in accordance with the Declaration of Helsinki. Written informed consent to participate in the study was obtained from all individuals.
Iris fixation of IOLs had been performed on 14 patients if there was dislocated one-piece foldable and the iris support adequately. Various reasons for IOLdislocation into the vitreous cavity were included. The follow-up time of patients was for a mean of 11,3 ± 2, 0 (range: 9–15) months. The SSFIOL group consisted of 15 patients with dislocated three-piece foldable IOL. The follow-up time of patients was for a mean of 11,8 ± 2,2 (range: 9–16) months. IOLhaptics of two patients also had distorted or broken during the operation and been switched with new IOL (Eyecryl plus TP6130® Biotech Vision care, Ptv., Ltd. Ahmedabad, Gujarat, India). Refractive error was determined with an auto refractometer (Auto Ref/ keratometry ARK-1s Nidek co., Ltd. Japan). All patient charts were reviewed for functional and anatomical outcomes in detail baseline demographic, ocular, and systemic characteristics of all patients are demonstrated in Table 1.
Table 1
The baseline demographic and clinical characteristics
|
ISIOL Group
|
SSFIOL Group
|
p
|
Eyes/patients
|
14/14
|
15/15
|
|
Sex (M/F)
|
9/6
|
8/7
|
0,84
|
Age (mean + SD, y)
|
67,9 ± 14,4
|
66,8 ± 12,0
|
0,82
|
Laterality (R/L)
|
6/8
|
7/8
|
0,83
|
Preoperative BCVA
Postoperative BCVA
1rd Month
6th Month
9th Month
|
0.05 ± 0.05
0.29 ± 0.11
0.45 ± 0.08
0.53 ± 0,13
|
0.05 ± 0.2
0.34 ± 0.11
0.50 ± 0.12
0.64 ± 0.16
|
0.87
0.21
0.21
0,05
|
Preoperative IOP
Postoperative IOP
1rd Month
6th Month
9th Month
|
15,3 ± 1,3
17,7 ± 1,2
15,5 ± 1,0
15,3 ± 1,1
|
15,0 ± 1,4
15,7 ± 0,7
15,1 ± 0,7
15,0 ± 0,7
|
0.47
0.001
0.23
0.37
|
Postoperative SEP
|
1,13 ± 0,39
|
0,63 ± 0,27
|
0.001
|
Follow-up (mean ± SD mo.)
|
11,3 ± 2, 0
|
11, 8 ± 2, 2
|
0,58
|
Diabetes Mellitus
Hypertension
Cardiac Disease
Thyroid Disease
|
3
7
2
1
|
4
6
3
|
|
M: Male, F: female, SD: standard deviation, y: year, mo: month, R: right, L: left, IOP: Intraocular pressure, SEP: spherical equivalent power, |
Surgical Techniques
All surgeries were performed under peribulbar anesthesia by a single surgeon (EA). A complete 23-gauge three-port pars plana vitrectomy (Dorc Eva, DORC B.V, Kerkweg 47e, 3214 VC Zuidland, Netherlands) was performed, removing the posterior hyaloid and with enough vitreous to free the dislocated PCIOLs from its vitreous attachments. Perfluorocarbon liquid (perfluoro-decline)was introduced in the vitreous cavity to maintain a bubble under the lens and to ensure it floats outwards out of the macular area. At this time, a dispersive ophthalmic viscosurgical device (OVD) is introduced into the anterior chamber. Firstly, the dropped PCIOLswere removed from the bag complex in the center of the vitreous (Fig. 1a). The haptics of PCIOLs was grasped by serrated micro forceps and taken into the anterior chamber with support of the endoilumination pipe (Fig. 1b). If the pupil is dilated, MIOSTAT (Alcon % 0.01,0.1–0.2 ml) can be injected to make it constricted. After optical capture of PCIOL, one of the haptics should be placed beneath the iris at three and 9 o'clock, and corneal paracentesis should be made at the same quadrants (Fig. 1c). The reduced infusion flow causes anterior elevation of the IOL, bringing it closer to the posterior iris. The stitches are thrown using the modified Mc Cannel technique (single-armed 10 − 0 polypropylene CIF-4 or CTC-6L (loop)needle (Ethicon, Inc., Somerville, NJ) that should pass widely around both haptics (6)(Fig. 1d). Both ends of the stitches are gently pulled to check for movement of the IOL, then tied (Fig. 1e) and trimmed by removing out through a subsequent limbal paracentesis incision with a hook (Fig. 1f).
The SSFIOL technique was used as described by Yamane et al. [10] and modified with 27G trocars in our usage. After performing a 23-gauge three-port pars plana vitrectomy (Dorc Eva, DORC B.V, Kerkweg 47e, 3214 VC Zuidland, The Netherlands), the haptics of PCIOLs was grasped by serrated micro forceps and taken into the anterior chamber with support of the endoilimunation pipe (Fig. 2a, and b). Then, the transconjunctival scleral tunnels were prepared with 15-degree angulation using a 27-gauge trocar at the 2:30 − 03:00 and 8:30-09:00 positions 2 mm away from the surgical limbus (Fig. 2c). The first haptic was pushed into the lumen of 27 G trocar with 27G serrated forceps (DORC B.V., Kerkweg 47e, 3214 VC Zuidland, The Netherlands) and the first haptic was externalized at 03:00 by sliding up the cannula of 27 G trocar (Fig. 2d). A terminal knob was formed by flanging the haptic with a battery-operated thermal cautery unit (Bovie Low-Temperature Cautery Fine Tip, Purchase, NY) (Fig. 2e). The created knob was pushed and fixed into the scleral tunnel. The same procedure was performed for the second haptic at the 8:30 position (Fig. 2f). Yamani technique was modified with a 27 G trocar system for dropped PCIOL. After implantation of the IOL, the corneal incision was hydrated with the balanced salt solution following intracameral viscoelastic removal.
Statistics
All statistical analyses were performed using SPSS version 18.0 (SPSS Inc, Chicago, Illinois, USA). The distribution of the continuous variables was determined by the Kolmogorov–Smirnov test. Continuous variables were compared using independent t-tests, Wilcoxon signed-rank tests, and Mann- Whitney U tests, and categorical variables were compared using Pearsonx2 tests. P < 0.05 was considered statistically significant.