Clinical Outcomes of Secondary Scleral-Sutured Foldable Hydrophilic Acrylic Intraocular Lens Placement by Trainees: A Single-Site Analysis
Received 25 December 2020
Accepted for publication 10 February 2021
Published 24 February 2021 Volume 2021:15 Pages 783—790
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Scott Fraser
Yesha S Shah,1 Angela Y Zhu,1 Sidra I Zafar,1 Daniel Sarezky,1 Ximin Li,2 TY Alvin Liu,1 Mira M Sachdeva,1 Fasika A Woreta1
1Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA; 2Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Correspondence: Fasika A Woreta
Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Medical Institutions, 600 N. Wolfe St., Wilmer B-29, Baltimore, MD, 21287, USA
Tel +1 410 955-8265
Fax +1 410 614-9632
Purpose: To evaluate the outcomes of a 4-point scleral-fixated foldable Akreos AO60 intraocular lens (IOL) insertion using Gore-Tex suture performed by trainees under supervision of a single attending surgeon.
Methods: Retrospective chart review for 53 eyes of 50 patients whose surgery was performed by trainees under supervision of a single surgeon between 2015 and 2018 at a tertiary care hospital (Johns Hopkins Wilmer Eye Institute, Baltimore, MD). Indications for surgery, preoperative risk factors, and intraoperative techniques were analyzed. Outcome measures included final best-corrected visual acuity (BCVA), change in BCVA, difference between expected and final spherical equivalent (SE), and postoperative complications.
Results: Mean patient age was 62.8 years (range 26.9 to 88.4). The most common indication for surgery was IOL dislocation (59.6%) due to trauma in 21 cases (40.4%) and pseudoexfoliation in 6 (11.5%). Combined pars plana vitrectomy was performed simultaneously in 46 cases (88.5%). Mean BCVA improved from 20/100 to 20/40 (p < 0.001). The difference between expected and final SE was within 1.0 D in 28 cases (53.8%). Postoperative hypotony occurred in 12 eyes (21.2%) on day 1; all were resolved at last follow-up. Postoperative cystoid macular edema (CME) occurred in 20 cases (38.5%); 11 (21.2%) persisted through last follow-up.
Conclusion: Scleral-fixation of Akreos AO60 IOL in absence of capsular support can be performed by trainees under supervision and results in effective visual rehabilitation. Postoperative CME occurred at a higher rate than previously reported in the literature. Future studies should assess the rates of postoperative complications amongst different techniques of secondary IOL fixation performed by trainees to determine which is the safest.
Keywords: secondary IOL, scleral-fixated IOL, scleral-sutured IOL, Akreos, clinical outcomes
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