Author: Carlos Cruz (Portugal)
Co-authors: Carlos Cruz, Keissy Sousa, Marina João, Tiago Monteiro, Nuno Lopes, Christophe Pinto
Purpose
Aphakic IOL (intraocular lens) are used when there is no support for a bag IOL. Artisan® is one of the options for implantation. They can be performed either by corneal or scleral incision with known advantages in each option. This study aims to evaluate post-operative complications and outcomes relative to the type of the 6 mm incision performed (limbic versus scleral) for Artisan® insertion in aphakic patients.
Setting/Venue
Department of Ophthalmology, Hospital de Braga, Braga, Portugal
Methods
This retrospective cohort study includes all aphakic IOL implantation at a tertiary care center in Portugal between January 2017 and December 2019. The case files were retrieved from the electronic medical records using the ICD-9 3619 coding – posterior dislocation of lens, mechanical complication of intraocular lens or other complications due to cataract surgery. All eyes with a minimum follow-up of 12 months were included in the study. Patients over 18 years-old and with the following diagnosis were included: aphakia, traumatic cataract, posterior dislocation of lens, decreased corneal endothelium cell count, intracapsular cataract extraction, dislocated IOL, IOL exchange, posterior capsule rupture. Excluded criteria were: other ophthalmic or systemic pathology which interfere with visual acuity, phakic IOL, Nd:yag laser codification, insufficient data or follow-up. Collected data included: age, gender, laterality, baseline and postoperative best-corrected visual acuity (BCVA), spherical equivalent (SE), and intra-ocular pressure (IOP), type of incision (corneal versus scleral), concomitant surgery, date of diagnosis and surgery, ocular and systemic concomitant pathologies, and intraoperative and posterative complications. BCVA was recorded based on Snellen decimal scale. All data were verified before and 3, 6 and 12 months after surgery.
Results
After all data collection, 404 eyes were included in statistical analysis. According to the chosen criteria, 106 eyes were included. In 69,8% (n=74) eyes a corneal incision was made – C group – and in 30.2% (n=32) eyes the IOL was inserted via scleral incision – S group. No significant differences between groups were found regarding gender, age, ocular laterality or concomitant ocular pathology (p-values>0.05). The most common primary diagnoses were IOL complication or posterior dislocated lens fragments in both groups. Combined surgery was mostly done in S group (p-value=0.001). Regarding visual and refractive outcomes, there was a significant improvement of BCVA and SE in both groups from baseline to the end of follow-up period (p-values<0.05), without significant difference between groups (p-value>0.05). Intraocular pressure was also similar between groups. Complications were divided according to the affected segment in anterior, posterior or both segments, with all categories showing no significant difference between groups (p-value=0.44, 0.55, and 0.85, respectively). The only reported anterior complications in group S were corectopia and corneal pigmentation. No complications were reported in 60.8% (n=45) and 68.8% (n=22) eyes in group C and S, respectively.
Conlusions
This study reported good and similar visual and refractive outcomes for Artisan® aphakia lens implantation either via scleral or limbic incision. Complications were also reported with a non-significant difference between both groups, concluding that Artisan® aphakia lens implantation is an effective procedure regardless the type of incision (scleral or limbic) with no outcome differences between the two techniques. Although anterior complications are statistically similar between groups, they have a tendency to be more varied and serious in group C. Since group S has a significative smaller sample size, a further study with a larger sample is needed in order to confirm or refute this tendency for better anterior segment outcomes in group S. The wide range of complications and different primary and associated diagnosis, and the statistically significative greater number of combined surgeries in group S, increases the likelihood of a confounding factor(s).
Financial Disclosure
This research received no financial support. The authors declare no financial, institutional nor commercial interests related to the research.
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