Assessment of refractive outcomes in eyes that underwent intraocular lens implantation in the posterior chamber but not "in-the-capsular bag:" A comparative retrospective study.

PURPOSE: The purpose of this study was to report visual and refractive outcomes in eyes that underwent intraocular lens (IOL) fixation in the absence of capsular support. METHODS: This was a retrospective chart review of cases undergoing posterior chamber iris-fixated IOL (IFIOL) and scleral-fixated IOL (SFIOL) implants from June 2014 to March 2020 with more than 3 months of follow-up and having a preoperative best-corrected visual acuity of 20/80 and more. RESULTS: Records of 120 eyes of 112 patients were reviewed. The mean age of the patients was 46.9 ± 22.3 (14.4-98.0) years, and 62% (n = 70) of participants were male. Most of the eyes (102: 85%) were aphakic at the time of surgery. The mean follow-up was 22.95 ± 17.1 months. The efficacy index of sutured IFIOL and glued SFIOL outperformed sutured SFIOL at 3 months and final visits postoperatively (P < 0.001). All techniques studied here resulted in a similar safety index at 3 months (P = 0.4). The mean predictive error (postoperative spherical equivalent refraction minus intended target refraction) was +0.07 ± 1.5 D and -0.12 ± 1.4 D at 3 months and the final postoperative visit, respectively. CONCLUSION: The studied techniques have relatively good visual and refractive outcomes in this series. In addition, techniques involving a small corneal incision with foldable IOL fixation to the iris or scleral tissue have superior efficacy and safety indices compared to creating large corneoscleral wounds for rigid IOL fixation techniques.

Development of Posterior Lenticonus Following the Diagnosis of Isolated Anterior Lenticonus in Alport Syndrome.

Alport syndrome is a genetic disorder that manifests as renal disease, hearing loss and ocular dysfunction. Lenticonus is one such ocular condition, in which the lens takes on an abnormal cone shape, with a protrusion either at the front or back of the lens. Both sides of the lens are rarely affected at the same time in the general patient population. Although anterior lenticonus is the type that is often reported in Alport syndrome, it is rare for such patients to have both anterior and posterior lenticonus. Here, the case of a 32-year-old male with Alport syndrome is described. The patient was diagnosed with a progressive posterior lenticonus, having been diagnosed eight years earlier with isolated anterior lenticonus. Examination of the eye revealed the typical indications of lenticonus with flecked retinopathy. The patient had co-presenting astigmatism and a refractive error, which could not be corrected by wearing contact lenses or spectacles. It is critical that such cases are anticipated and identified prior to performing surgery, so that an appropriate approach can be taken, thereby minimizing surgical complications.