Journal of Cataract and Refractive Surgery, volume 51, issue 3, pages 257-266

Postoperative complication rates in intraocular lens placement and fixation methods for inadequate capsular bag support: a review and meta-analysis

Piotr Kanclerz 1, 2
, 
Szymon Adam Radomski 1
, 
Idan Hecht 2, 3, 4
, 
R. Tuuminen 2, 5
1
 
Hygeia Clinic, Department of Ophthalmology, Gdańsk, Poland | 
2
 
3
 
4
 
5
 
Eye Centre, Kymenlaakso Central Hospital, Kotka, Finland | 
Publication type: Journal Article
Publication date: 2025-03-01
scimago Q1
SJR: 1.472
CiteScore: 5.6
Impact factor: 2.6
ISSN: 08863350, 18734502
Abstract
Topic:

To evaluate the complication rates of different intraocular lens (IOL) placement methods in adults with inadequate capsular bag support.

Clinical Relevance:

The surgical correction of inadequate capsular bag support for the IOL harbors several challenges, and there is a wide range of surgical procedures.

Methods:

For the purpose of this meta-analysis, surgical methods were grouped based on the location of IOL placement: (1) anterior chamber (AC) placement; (2) iris fixation, which included prepupillary or retropupillary placement of an iris-claw IOL, or iris suturing of an IOL; and (3) scleral fixation, which included scleral sutured and sutureless techniques. Only studies comparing the results of 2 or more different placement methods were analyzed. The study protocol has been registered in the PROSPERO database (CRD42023458557).

Results:

15 studies were included in the final analysis, which reported results of 1247 eyes. The overall complication rate was nonsignificantly lower in iris fixation (4.4%; 95% CI, 3.6%-5.4%, P = .150) than in AC placement (7.4%; 95% CI, 6.4%-7.9%) and scleral fixation (7.4%; 95% CI, 6.5%-8.4%). Transient corneal edema was the most common complication in AC placement (29.9%; 95% CI, 2.4%-57.5%, P < .001), compared with scleral fixation (11.9%; 95% CI, 2.6%-21.2%) and iris fixation (4.1%; 95% CI, 0.8%-7.3%). Vitreous hemorrhages were more frequently reported after scleral fixation (8.5%; 95% CI, 6.3%-11.2%, P = .006) than in AC placement (5.4%; 95% CI, 3.4%-8.5%) and iris fixation (1.4%; 95% CI, 0.4%-4.2%), and so was IOL decentration/dislocation (8.9%; 95% CI, 6.7%-11.8%, P = .047 compared with 1.1%; 95% CI, 0.4%-3.4% and 4.0%; 95% CI, 2.2%-7.3%, respectively).

Conclusions:

The risks associated with particular techniques should be taken into account in preoperative counseling and planning postoperative treatment.

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