More support for iris fixation of subluxated IOLs

The results of this retrospective study add to the evidence that iris suture fixation of subluxated IOLs is safe and effective in pseudophakic eyes.

This article is noteworthy in part because the rate of late in-the-bag IOL luxation appears to be increasing, a complication that may be dealt with in various ways surgically. However, the rate of re-subluxation in this paper is quite high at 7 out of 72 eyes over a mean follow-up of 4 months.

The authors reviewed the charts of 67 consecutive patients (72 eyes) with subluxated IOLs who underwent iris suture fixation at one academic center. They excluded posterior dislocations necessitating pars plana vitrectomy, secondary implantations for aphakia and iris suture fixation at primary cataract extraction. All patients had preoperative monocular diplopia or unstable vision attributable to the subluxated intraocular lenses, and 40.3% required aphakic correction.

Over a mean follow-up of 16.6 months, BCVA significantly improved from logMAR 0.35 to logMAR 0.21, spherical equivalence was reduced and astigmatism did not significantly change.

Most IOLs (93.55%) were stable and centered at the final follow-up. However, re-subluxations occurred in 7 eyes, with the majority of these eyes undergoing repeat fixation, and glaucoma developed in 2 eyes. The early re-subluxations resulted from sutures that were not tight enough whereas the late re-subluxations were due to intact suture erosion through the iris stroma. Five of the re-subluxations occurred in eyes that underwent IOL exchange. A history of retinal detachment and of scleral buckle were associated with a shorter period between iris suture fixation and re-subluxation.

The authors conclude that iris suture of IOLs in pseudophakic eyes should be part of the cataract surgeon’s armamentarium.