| Objective: To investigate the efficacy of two different types of intraocular lens(IOL)sclera suspension fixation: the wireless junction intraocular lens(IOL)via ciliary sulcus sclera suture fixation and the intraocular sclera internal fixation without sutures.Methods:This study was designed as a retrospective,case-control study.All enrolled patients were collected from patients undergoing IOL sclera fixation surgery at Shenyang He's Eye Hospital from January 2015 to June 2019.A total of 39 cases(40 eyes)were divided into two groups(A and B)according to different surgical methods.Group A consisted of 18patients(19 eyes)whose surgical method is wireless junction intraocular lens(IOL)via ciliary sulcus sclera suture fixation,while group B consisted of 21 patients(21 eyes)with intraocular sclera internal fixation without sutures.All the patients were operated by the same surgeon in the hospital.The best corrected visual acuity(BCVA),corneal endothelial cell count,operation time of each patient and incidence of early and late postoperative complications were collected and recorded.SPSS 24.0 software was used for statistical analysis of the obtained inter-group data(P<0.05 was statistically significant).Corneal edema,abnormal intraocular pressure,vitreous hemoperitoneum and short-term complications related to surgery were collected from the two groups.During the follow-up,long-term complications such as suture exposure,intraocular lens position,intraocular lens redislocation,macular edema and retinal detachment were recorded.Results: 1.The operation time in group A was 34.3±7.4min,and that in group B was 22.7±8.0min.There was a statistical difference in the operation time between groups A and B(P=0.000,P<0.05).2.The best corrected visual acuity before the operation was Log MAR0.35±0.24 in group A and log MAR0.37±0.26 in group B,there was no statistically significant difference between the two groups(P=0.861,P>0.05).One week after the surgery,the best corrected visual acuity in group A was Log MAR0.48±0.17 versus log MAR0.36±0.14 in group B,there was a statistical difference between the two groups(P=0.018,P<0.05).6 months after surgery,the best corrected visual acuity of group A was log MAR0.25±0.15,and that of group B was log MAR0.24±0.14,respectively.There was no statistical difference between the two groups(P=0.753,P>0.05).It was concluded that the operative method in group B was faster than that in group A in improving the postoperative vision of the patients,and the long-term observation of the visual recovery of the two groups was similar.3.Preoperative corneal endothelial count was 2480±332/mm in group A and 2376±317/mm in group B,showing no statistically significant difference(P=0.972,P>0.05).6 months after surgery,corneal endothelial count was 2414±321/mm in group A and 2275±297/mm in group B,still showing no statistically significant difference(P=0.843,P>0.05).The results showed that the number of corneal endothelial cells decreased in the two groups.4.IOP(intraocular pressure): IOP were measuredat 1 day,1 week and 3 months after surgery.1 day after the operation,there was 1 case of low intraocular pressure in group A.After bandaging and quiet rest for 1 week the patient's IOP returned to normal.1 day after the operation,there were 2 patients in group A had high intraocular pressure,and 1 patient in group B had high intraocular pressure,but both of them did not exceed 30 mmhg.The high IOP operated eyes both in group A and B were treated with Carteolol eye drops 2% bid for 1 week after surgery and the IOP returned to normal.The intraocular pressure in group A and group B was normal after 3 months after the operation.5.Postoperative complications: Early complications: There were 1 case(5.3%)of corneal edema,2 cases(10.5%)of high IOP,1 case(5.3%)of low IOP,and 1 case(5.3%)of vitreous hemorrhage in group A;In group B,1 case(4.8%)had high intraocular pressure and 2 cases(9.5%)had vitreous hemoperitoneum.Late complications: 5 cases of suture exposure(26.3%),1 case of IOL dislocation(5.3%),1 case of retinal detachment(5.3%),1 case of macular edema(5.3%),and 1 case of iris capture of IOL(5.3%)in group A.In group B,1 case(4.8%)had macular edema and 1 case(4.8%)had iris capture of IOL,and no high intraocular pressure was observed.The overall incidence of early complications was 26.3% in group A and 14.3% in group B.The overall incidence of late complications was 21.5% in group A and 9.5% in group B.Since only group A needed hanging suture during the operation,the complication of late suture exposure was not included in the comparison between the two groups.The incidence of early and late complications in group B was lower than that in group A,but there was no statistical difference between the two groups(P>0.05).Conclusion: 1.Both sutured sulcus sclera suture suspension and sutured intraocular lens internal sclera fixation can significantly improve the visual quality of patients with acentulous eyes who lack effective capsule support.Both of the two surgical methods are safe and feasible,and can be used as the choice for this kind of surgery.2.Suture-free intraocular lens scleral internal fixation is a new technique for intraocular lens suspension and fixation in recent years.The operation is short in time,and the postoperative vision improves and recovers rapidly,which avoids suture-related complications in traditional and previous modified suspension operations,and the incidence of other short-term and long-term complications is also low.At the same time,this surgical method is less consumables,and the patients' cost is reduced,so it is worthy of clinical application.3.In this study,the number of patients in the two groups was limited,and large sample control was lacked.The long-term stability of intraocular lens scleral internal fixation surgery still needs a longer follow-up. |
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