Long term outcomes of combined pars plana with placement of anterior chamber versus glued posterior chamber intraocular lens

Alexis Warren, MD, Pavlina Kemp, MD, Razek G. Coussa, MD, Liang Cheng, MD, H. Culver Boldt, MD, Stephen Russell, MD, Thomas Oetting, MD, A. Tim Johnson, MD PhD, Elliott H Sohn, MD

BACKGROUND MATERIALS AND METHODS RESULTS A total of 25 eyes in 25 patients (7 females and 18 males) met the inclusion criteria Current literature suggests that despite having an acceptable visual outcome, an We conducted a retrospective consecutive chart review on patients who underwent PPV with concomitant and were analyzed. There were 12 patients in the ACIOL group and 13 patients in anterior chamber intraocular lens (ACIOL) have a relatively higher rate of placement of either anterior chamber or fibrin glued posterior chamber lens (PCIOL) for , dislocated IOL or the fibrin glued PCIOL group. The mean age in the ACIOL group was 70.4 years age complications than its posterior chamber equivalent. Most notably, ACIOLs have dropped crystalline lens at the University of Iowa Hospitals and Clinics from 2/9/2000 to 5/7/2018. IRB approval while the mean age of the fibrin glued group was 54.6 years of age (p= 0.03). been associated with endothelial cell loss corneal decompensation. The exact was obtained. Patients with less than 32 weeks of follow up were excluded. Detailed pre-intra-, and post-operative Median follow up was 120 weeks. The mean Snellen equivalent best corrected mechanism for the endothelial cell loss remains unknown, as this is likely data were compiled, and statistical analysis was performed. visual acuity (BCVA) pre-operatively was 20/588 in the ACIOL group and 20/134 in multifactorial. Previous studies have highlighted direct mechanical trauma from the the fibrin glued PCIOL group (p = 0.12) with a final BCVA of 20/341 and 20/90 lens and/or subclinical inflammatory mediators for the morphologic changes and Fibrin Glued IOL ACIOL p value respectively (p =0.15). There was no difference in the mean change in visual acuity accelerated endothelial cell loss however, this topic remains controversial, as more Number of patients 13 12 -- at the final visit between the two groups (p = 0.47). Neither group had recent literature has shown this association may be complicated by other Mean age (range) 54.6 (19-83) 70.4 (27-92) 0.03* suprachoroidal hemorrhage or choroidal detachment intraoperatively. Post- confounding variables like intraoperative surgical micro trauma from surgical operatively, there was no significant difference in corneal decompensation between instrument manipulation which is present regardless of lens type. Nonetheless, Sex 2 Females 5 Females 0.28 placement of ACIOL or fibrin glued PCIOL lenses (33% and 31% respectively, p = efforts continue to develop new suture and scleral fixated techniques in hopes to Mean follow-up (weeks) 142.2 192.8 0.25 0.93. improve visual acuity outcomes and binocularity in addition to decrease the known Mean preop VA (logMAR) 20/134 20/587 0.07 complication profiles that accompany an ACIOL. Fibrin Glued Co-morbidities 0.35 IOL ACIOL p value 3 3 Mean pre-op visual acuity PURPOSE AND HYPOTHESIS Myopia 1 1 Uveitis 1 1 (Snellen) 20/134 20/587 0.07 Type II Diabetes 2 0 Mean final post-op visual As these new surgical advances arise, studies emerge to detail the differences in the long term sequalae of anterior chamber intraocular lenses to scleral fixated AMD 0 3 acuity (Snellen) 20/90 20/341 0.15 posterior chamber intraocular lenses, but few studies directly compare the two, ERM 1 2 Mean change in visual especially in the setting of concurrent pars plana vitrectomy. This study is aimed to CME 0 1 evaluate the differences in long term clinical outcomes in patients with combined acuity (logMAR ) -0.28 +/- 0.37 -0.24 +/- 0.63 0.47 pars plana vitrectomy (PPV) and placement of anterior chamber intraocular lens Retinal detachment 6 6 Table 3. Visual acuity outcomes (ACIOL) versus posterior chamber -assisted intraocular lens Table 1 . Baseline demographics CONCLUSIONS Fibrin Glued Complications IOL ACIOL p value • Posteriorly subluxed lenses often require vitrectomy with intraocular lens Intra-operative Suprachoroidal hemorrhage 0 0 0.98 exchange (IOL) and/or IOL fixation. • Choroidal detachment 0 0 0.98 Anterior chamber lenses and scleral fixated posterior chamber lenses with combined vitrectomy have similar long-term complication profiles. Post-operative Suprachoroidal hemorrhage 0 2 0.50 • Combined with either lens technique results in similar improvements in vision. Choroidal detachment 0 0 0.98 Unstable IOL 2 2 0.98 REFERENCES Glaucoma 0 0 0.74 UGH 0 0 0.98 1. Apple DJ, Mamalis N, Loftfield K, et al. Complications of intraocular lenses. Corneal decompensation 4 3 0.93 A historical and histopathological review. Surv Ophthalmol. 1984;29(1):1- 54. Retinal detachment 0 0 0.98 2. Biro Z. Results and complications of secondary intraocular lens CME 1 6 0.08 implantation. J Refract Surg. 1993;19(1):64-67. ERM 1 2 0.73 3. Matsuda M, Miyake K, Inaba M. Long-term corneal endothelial changes VH 2 2 0.98 after intraocular lens implantation. Am J Ophthalmol. 1988;105(3):248-252. Figure 1. A. An anterior chamber intraocular lens. B. Still frame of the implantation Hyphema 0 0 0.98 4. McAllister AS, Hirst LW. Visual outcomes and complications of scleral- of a scleral fixated posterior chamber intraocular lens fixated posterior chamber intraocular lenses. J Cataract Refract Surg. 2011;37(7):1263-1269. Table 2. Intra and post-operative surgical complications 5. https://eyerounds.org/atlas/pages/ACIOL/index.htm