Scleral-Sutured Intraocular Lens Dislocations Secondary to Eyelet Fractures.

OBJECTIVE: To report clinical features and visual outcomes following eyelet fractures of scleral-sutured enVista MX60 (Bausch + Lomb) intraocular lenses (IOL). DESIGN: Retrospective, multi-center, multi-surgeon, observational case series. METHODS: Study Population: Patients with scleral-sutured enVista MX60 IOLs that experienced either an intraoperative or post-operative eyelet fracture associated with dislocation or subluxation. PROCEDURES: All records were reviewed for patients with a dislocated or subluxed scleral-sutured enVista MX60 IOL. Clinical features and outcomes were gathered. Main Outcome Measures: Clinical setting, surgical technique, complications, and visual acuity. RESULTS: A total of 25 scleral-sutured enVista MX60 IOLs displacements secondary to eyelet fractures in 23 eyes of 23 patients were included. There were 20 IOLs that sustained a postoperative fracture and 5 IOLs that sustained an intraoperative fracture. Of the postoperative fractures, 7 were dislocated and 13 were subluxed. Gore-Tex was the suture of choice for 19 of the postoperative fractures and all 5 of the intraoperative fractures, and Prolene was used for 1 postoperative fracture. The mean time until postoperative fracture was 96 ± 125 days, and the median time was 61 (IQR 48-144) days. Of the postoperative fractures, new MX60s were sutured in 10 patients, and 2 of them experienced repeat displacements due to a new eyelet fracture. In the intraoperative fracture group, new MX60s were sutured in 4 patients and an Akreos AO60 lens was placed in the 5th patient. The mean preoperative best-corrected logMAR visual acuity for all patients improved from 1.2 ± 0.8 (20/317 Snellen equivalent) to 0.5 ± 0.5 (20/63 Snellen equivalent) at most recent follow-up after lens replacement. CONCLUSIONS: Scleral-sutured MX60 intraocular lenses can experience intraoperative or postoperative eyelet fractures, resulting in lens subluxation or dislocation. Surgeons should be aware of this complication when evaluating secondary intraocular lens options.

An update on postrefractive surgery intraocular pressure determination.

PURPOSE OF REVIEW: Due to alterations in corneal structure and biomechanics, intraocular pressure (IOP) measurement after refractive surgery has questionable accuracy. Numerous devices and techniques have been evaluated in the past decade. Whereas some methods clearly underestimate postoperative IOPs, other promising leads have emerged that are less affected by laser ablative procedures. RECENT FINDINGS: It is well established that Goldmann applanation tonometry (GAT) underestimates IOP after refractive surgery. The discussion on the accuracy of different techniques of IOP measurement after refractive surgery remains ongoing. Evidence suggests that techniques that are less reliant on corneal structure and biomechanics may provide less altered IOPs postoperatively. Therefore, devices such as Dynamic Contour Tonometry and tonopen may have great utility after laser ablative surgery. SUMMARY: GAT may not be the best method of measuring IOP after refractive surgery. Other devices may be superior to the GAT in providing more accurate IOP postoperatively. It is imperative that clinicians are aware of the possible inaccuracy of IOP acquisition after refractive surgery, in order to provide optimal monitoring for the development and progression of glaucoma.