Factors Affecting Visual Outcomes Following Scleral-Fixated Intraocular Lens Implantation at a Tertiary Care Center in Eastern India

Background: Lens implantation becomes a major concern in patients lacking posterior capsular support, but various methods are available for rehabilitation. In such patients, scleral-fixated intraocular lens (SFIOL) implantation is preferred due to its fewer complications and better simulation of the natural lens position. In this non-randomized retrospective clinical study, we aimed to assess visual outcomes after sutureless SFIOL implantation in aphakic patients and factors affecting visual outcomes.

Materials and methods: The study was conducted at the Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India, wherein a retrospective data analysis of hospital medical records of aphakic cases who underwent SFIOL implantation from January 2020 to December 2022 was performed. Patients with poor capsular and iris support, lens subluxation of >180°, dislocated natural crystalline lens, or intraocular lens were included in the study. Preoperative data such as aphakia etiology, pre-op best-corrected visual acuity (BCVA), intraocular pressure (IOP), and any other ocular pathology, as well as postoperative data (i.e., BCVA, IOP, haptic status, and complications), were collected and analyzed.

Results: A total of 45 patients underwent non-sutured multipiece SFIOL implantation. The average preoperative BCVA was 1.73±0.24 (in LogMAR, logarithm of the minimum angle of resolution), which improved to 0.87±0.27 six months after surgery. Out of 45 patients, 41 (91.1%) reported increased BCVA. The most common intraoperative and postoperative complications were astigmatism, raised IOP, and corneal edema. Four (8.9%) patients had no change in BCVA due to pre-existing conditions. No patient required a second surgery for retinal detachment or dislocation of SFIOL. Two (4.4%) patients underwent laser treatment for a retinal break found incidentally during surgery.

Conclusion: Sutureless SFIOL demonstrates predictable outcomes post-aphakia. Patient outcomes ultimately depend on the presence of postoperative astigmatism and coexistent anterior and posterior segment pathologies. Surgeons should take appropriate care to avoid IOL tilt and postoperative astigmatism.