Author: Anubhav Garg (Canada)
Co-authors: Anubhav Garg, Tsz Hin Alexander Lau, Marko Popovic, Peter Kertes, Rajeev Muni
Purpose
We aim to compare the efficacy and safety outcomes following scleral fixated (SF) versus anterior chamber (AC) intraocular lens (IOL) implantation in adults.
Setting/Venue
A systematic literature search was performed on Ovid MEDLINE, EMBASE, and Cochrane CENTRAL from 2005-2020.
Methods
Inclusion criteria were the following: adult patients, comparison of SFIOL and ACIOL implantation, sample size of at least 5 eyes per group, and English-language articles. Studies reporting on concurrent surgery were excluded. 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 in Non-randomized Studies – of Interventions (ROBINS-I) tool was completed for all studies. Certainty of evidence for outcomes was evaluated via the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool.
Results
411 eyes from 5 studies were included. Mean follow-up was 27±21 months. There was no significant difference between techniques for mean CDVA from 1 month to 1 year postoperatively (P=0.13) or at final follow-up (P=0.13). ACIOL implantation was significantly more likely to result in a higher proportion of patients achieving final CDVA 20/40 or better (RR=0.76,95%CI=[0.61,0.95],P=0.01). There was no significant difference in final ECD (P=0.60). Techniques were not significantly different in the incidence of perioperative (P=0.18) or early postoperative (P=0.31) complications. SFIOL implantation was significantly more likely to lead to late postoperative complications (RR=1.57,95%CI=[1.11,2.22],P=0.010) and vitreous hemorrhage (RR=2.33,95%CI=[1.13,4.81],P=0.02).
Conlusions
There was no significant difference between ACIOL and SFIOL implantation for mean CDVA, but when analyzed as a categorical variable, a significantly greater proportion of patients achieved final CDVA 20/40 or better following ACIOL implantation. SFIOL implantation was associated with a higher incidence of late postoperative complications and vitreous hemorrhage relative to ACIOLs. Overall, the quality of evidence in this setting is limited, and future prospective studies are needed to confirm these findings.
Financial Disclosure
PK: Advisory board – Novartis, Alcon, Bayer; Financial support (to institution) – Allergan, Bayer, Roche, Novartis; Financial support – Novartis, Bayer, Novelty Nobility; Equity owner – ArcticDx. RM: Advisory board- Bayer, Novartis, Allergan, Roche; Financial Support (to institution)- Bayer, Novartis.
Comments
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