title: Small-incision 4-point scleral suture fixation of a foldable hydrophilic acrylic intraocular lens in the absence of capsule support.
abstract: OBJECTIVE
  To determine the visual outcomes and complications of a new small-incision technique for 4-point fixation of a hydrophilic acrylic posterior chamber intraocular lens (IOL) in the absence of capsule support.
  
  
  METHODS
  Three North American tertiary referral centers and a private practice.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Secondary IOL placement was performed from 2011 to 2014. Indications for surgery, clinical results, and complications were analyzed. Primary outcomes included postoperative corrected distance visual acuity (CDVA) and surgical complications.
  
  
  RESULTS
  Charts of 35 patients (37 eyes) were reviewed. The mean age at surgery was 56 years, and the mean follow-up was 6 months (range 3 to 24 months). Clinical indications included a dislocated IOL (30%), ocular trauma (19%), crystalline lens subluxation (19%), uveitis-glaucoma-hyphema syndrome (5%), post-complicated cataract (8%), congenital cataract (8%), and decompensated cornea (3%). The mean CDVA improved from 20/80 preoperatively to 20/40 postoperatively (P < .01). Thirty-six eyes (97%) had an improved or unchanged CDVA, and 1 eye (3%) had a reduced CDVA because of worsening glaucoma. Postoperative complications included ocular hypertension (24%), iritis (5%), wound leakage (3%), transient corneal edema (3%), glaucoma requiring a tube shunt (3%), and IOL dislocation (3%).
  
  
  CONCLUSIONS
  Small-incision 4-point scleral fixation of the Akreos AO60 hydrophilic acrylic IOL in the absence of capsule support appears to be a safe and effective technique for secondary IOL placement.
  
  
  BACKGROUND
  Drs. Berdahl and Ayres are consultants to Bausch & Lomb, Inc. Drs. Ayres and Fram have received speaker fees from Bausch & Lomb. Dr. Terveen does not have a financial or proprietary interest in any material or methods mentioned.
authors.affiliation: From the University of South Dakota Sanford School of Medicine (Terveen, Berdahl), and Vance Thompson Vision (Berdahl), Sioux Falls, South Dakota, the University of Iowa Hospitals and Clinics (Terveen), Iowa City, Iowa, Advanced Vision Care and Jules Stein Eye Institute (Fram), David Geffen School of Medicine, University of California, Los Angeles, California, the Cornea Service (Ayres), and Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. Electronic address: dcterveen@gmail.com.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Terveen
authors.affiliation: From the University of South Dakota Sanford School of Medicine (Terveen, Berdahl), and Vance Thompson Vision (Berdahl), Sioux Falls, South Dakota, the University of Iowa Hospitals and Clinics (Terveen), Iowa City, Iowa, Advanced Vision Care and Jules Stein Eye Institute (Fram), David Geffen School of Medicine, University of California, Los Angeles, California, the Cornea Service (Ayres), and Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Nicole R
authors.initials: NR
authors.lastname: Fram
authors.affiliation: From the University of South Dakota Sanford School of Medicine (Terveen, Berdahl), and Vance Thompson Vision (Berdahl), Sioux Falls, South Dakota, the University of Iowa Hospitals and Clinics (Terveen), Iowa City, Iowa, Advanced Vision Care and Jules Stein Eye Institute (Fram), David Geffen School of Medicine, University of California, Los Angeles, California, the Cornea Service (Ayres), and Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Ayres
authors.affiliation: From the University of South Dakota Sanford School of Medicine (Terveen, Berdahl), and Vance Thompson Vision (Berdahl), Sioux Falls, South Dakota, the University of Iowa Hospitals and Clinics (Terveen), Iowa City, Iowa, Advanced Vision Care and Jules Stein Eye Institute (Fram), David Geffen School of Medicine, University of California, Los Angeles, California, the Cornea Service (Ayres), and Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Berdahl
mesh_terms: D000180:Acrylic Resins; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007903:Lens Capsule, Crystalline / Q000473:pathology*; D019654:Lens Implantation, Intraocular / Q000379:methods*; D007910:Lenses, Intraocular; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications; D019591:Pseudophakia / Q000503:physiopathology; D012189:Retrospective Studies; D012590:Sclera / Q000601:surgery*; D013536:Suture Techniques; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000180:Acrylic Resins