Long-term results of aphakia management by scleral fixation intraocular lens placement with knotless transscleral Z-suture method

Purpose To evaluate the long-term refractive outcomes and complications of posterior chamber intraocular lens placement by scleral fixation surgery (SF-IOL) with the knotless Z-suture method. Methods The authors retrospectively reviewed the medical records of patients who underwent SF-IOL placement with the Z-suture method between January 2010 and December 2018 and who attended a follow-up after at least 1 year. Preoperative and postoperative best-corrected visual acuity (BCVA), anterior segment biomicroscopy, fundus examinations, and postoperative complications were evaluated. Lenticular astigmatism was calculated through the vector analysis method. Results One hundred thirty-six eyes of 136 patients (mean age 57.78 +/- 22 years, 98 male/38 female) were included in the study. Of the 136 patients, 67 (49.3%) had a complicated cataract, 50 (36.8%) had pseudoexfoliation syndrome, and 19 (14%) had a trauma history. The mean follow-up period was 50.83 +/- 27 months. The mean preoperative BCVA was 0.65 +/- 0.24 LogMAR, and the postoperative BCVAs were: 0.40 +/- 0.30 (p < 0.001) at 1 year; 0.40 +/- 0.30 (p < 0.001) at 2 years; 0.41 +/- 0.31 (p < 0.001) at 3 years; 0.43 +/- 0.32 (p < 0.001) at 5 years; and 0.47 +/- 0.24 (p = 0.03) at 8 years. Complications included retinal detachment in 2 patients (1.5%), cystoid macular edema in 4 patients (2.9%), increase in intraocular pressure in 5 patients (3.6%), suture loosening in 3 patients (2.2%), and IOL dislocation in 3 patients (2.2%). Conclusion Scleral fixation of IOL with knotless Z-suture technique is an effective method to correct aphakia, with reliable long-term results.