Author: Tsz Hin Alexander Lau (Canada)
Co-authors: Tsz Hin Alexander Lau, Anubhav Garg, Marko M. Popovic, Peter J. Kertes, Rajeev H. Muni
To compare the efficacy and safety outcomes following scleral fixated (SF) vs iris fixated (IF) intraocular lens (IOL) implantation in adults.
A systematic literature search was conducted on Ovid MEDLINE, EMBASE, and Cochrane CENTRAL from 2005-2020. Inclusion criteria were as follows: adult patients, comparison of SF to IF IOL implantation or different techniques for SF or IF IOL implantation, sample size of at least 5 eyes in each group, and English language articles. Outcomes included corrected distance visual acuity (CDVA), endothelial cell density (ECD), and incidence of complications. Meta-analysis was conducted using a random effects model in which weighted mean differences (WMD) and risk ratios (RR) with 95% confidence intervals (95%CI) were computed. The Risk of Bias 2.0 (RoB 2.0) tool was completed for randomized controlled trials (RCTs) and the Risk of Bias in Non-randomized Studies – of Interventions (ROBINS-I) tool was completed for non-randomized studies. The certainty of evidence for outcomes was evaluated via the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool.
1252 eyes from 7 RCTs and 14 cohort studies were included. Overall risk of bias was low to some concerns for RCTs and moderate for non-randomized studies. Mean follow-up was 14±12 months. There was no significant difference in mean CDVA between sutured SFIOL and IFIOL implantation (P=0.80) or sutureless SFIOL and IFIOL (P=0.43) at final follow-up. Absolute change in spherical equivalent (P=0.74) was not significantly different. Final ECD was significantly higher for sutured SFIOLs (WMD=283.30 cells/mm2,95%CI=[101.79,464.82],P=0.002) relative to IFIOLs. Risk of pupil distortion/ovalization was significantly higher in the IFIOL group (RR=0.05,95%CI=[0.01,0.33],P=0.002) relative to sutureless SF IOLs.
There were no differences in visual acuity and refractive outcomes between SFIOL and IFIOL implantation. Final ECD was significantly higher in the sutured SFIOL group compared to IFIOL. A significantly greater proportion of patients experienced pupil distortion/ovalization following IFIOL relative to sutureless SFIOL implantation. Future RCTs are needed to confirm these findings.
Conflicts of Interest: MMP: Financial support (to institution) – PSI Foundation. PJK: Advisory board – Novartis, Alcon, Bayer, Roche, Novelty Nobility; Financial support (to institution) – Allergan, Bayer, Roche, Novartis; Financial support – Novartis, Bayer; Equity owner – ArcticDx. RHM: Advisory board- Bayer, Novartis, Allergan, Roche; Financial Support (to institution)- Bayer, Novartis.