Refractive Outcomes of Retropupillary Fixated Iris-Claw Lens for Exchange of the Dislocated Intraocular Lens Using Modified Scleral Incisions

Figures & data

Figure 1 Representative photographs during the surgery and a schematic illustration of each incision type used; (A) a conventional 5.5-mm sclerocorneal incision, (B) L-shaped incision, and (C) frown incision.

Table 1 Demographic and Preoperative Ocular Characteristics of Enrolled Patients (n=107)

	All Patients (n=107)	Conventional Incision (n=60)	L-Shaped Incision (n=29)	Frown Incision (n=18)
Age, years	65.31 ± 12.15	66.91 ± 12.26	63.86 ± 11.77	62.38 ± 12.14
Range	31–91	43–91	43–87	31–83
		P = 0.179,† P = 0.797 for C vs L, P = 1.000 for L vs F, P = 0.254 for F vs C
Gender, male. (%)	80 (74.8)	43 (71.7)	24 (82.8)	13 (72.2)
		P = 0.164
UDVA, LogMAR	1.35 ± 0.70	1.39 ± 0.65	1.33 ± 0.74	1.21 ± 0.84
Range	0.00–2.00	0.16–2.00	0.20–2.00	0.00–2.00
		P = 0.613,† P = 1.000 for all subanalysis
CDVA, LogMAR	0.53 ± 0.65	0.58 ± 0.68	0.51 ± 0.65	0.36 ± 0.53
Range	0.00–2.00	0.00–2.00	0.00–2.00	0.00–2.00
		P = 0.466,† P = 1.000 for C vs L, P = 1.000 for L vs F, P = 0.658 for F vs C
SE, D	6.72 ± 5.60	6.60 ± 5.68	6.66 ± 5.82	7.18 ± 5.34
Range	−4.13–13.38	−4.13–13.38	−3.00–13.38	−2.25–13.25
		P = 0.938,† P = 1.000 for all subanalysis
Km, D	43.84 ± 1.46	44.11 ± 1.35	43.74 ± 1.66	43.35 ± 1.58
Range	40.64–47.65	41.80–47.65	40.71–47.28	40.64–45.67
		P = 0.177,† P = 0.861 for C vs L, P = 1.000 for L vs F, P = 0.208 for F vs C
Ka, D	−1.15 ± 1.00	−1.26 ± 1.22	−1.18 ± 0.69	−0.76 ± 0.33
Range	–6.05 – 0.00	–6.05 – 0.00	–3.10 – 0.00	–1.51 – 0.00
		P = 0.202,† P = 1.000 for C vs L, P = 0.510 for L vs F, P = 0.228 for F vs C
ECC, /mm^2	2452.29 ± 531.80	2381.29 ± 575.33	2474.20 ± 460.54	2590.61 ± 765.59
Range	1015.80–3979.00	1015.80–3367.40	1717.17–3250.80	1434.30–3979.00
		P = 0.437,† P = 1.000 for C vs L, P = 1.000 for L vs F, P = 0.600 for F vs C
IOP, mmHg	15.98 ± 4.92	15.73 ± 4.51	16.75 ± 4.36	14.06 ± 6.97
Range	8.00–29.00	8.00–28.00	9.00–29.00	12.00–20.00
		P = 0.459,† P = 0.930 for C vs L, P = 0.820 for L vs F, P = 0.867 for F vs C
Follow up period, month	36.67 ± 18.86	47.47 ± 17.23	28.50 ± 5.61	12.13 ± 4.65
Range	6–81	38–81	13–37	6–19
		P <0.001*,† P <0.001* for all subanalysis

Notes: Values are represented in frequency (percentage) for categorical variables, mean and standard deviation for continuous variables. ^†ANOVA was used to evaluate whether there is a significant difference between three groups. Bonferroni test was used for post hoc analysis.

Abbreviations: CDVA, corrected distance visual acuity; ECC, endothelial cell count; IOP, intraocular pressure; Ka, keratometric astigmatism; Km, mean keratometry; SE, spherical equivalent; UDVA, uncorrected distance visual acuity.

Figure 2 Standard graphs for reporting refractive outcomes. (A) Uncorrected distance visual acuity (UDVA). (B) The difference between UDVA and corrected distance visual acuity (CDVA). (C) Change in CDVA, (D) The comparison between attempted spherical equivalent (SEQ) refraction and achieved SEQ refraction. (E) The accuracy of SEQ to the intended target. (F) Spherical equivalent refraction stability after surgery. (G) The comparison between preoperative and postoperative refractive astigmatism.

Table 2 Comparison of the Postoperative 6 Month Analysis (n=107)

	All Patients (n=107)	Conventional Incision (n=60)	L-Shaped Incision (n=29)	Frown Incision (n=15)
UDVA, LogMAR	0.32 ± 0.41	0.47 ± 0.49	0.24 ± 0.23	0.06 ± 0.11
	0.00–2.00	0.00–2.00	0.00–1.00	0.00–0.40
		P = 0.003, P = 0.151 for C vs L, P = 0.536 for L vs F, P = 0.003 for F vs C
CDVA, LogMAR	0.18 ± 0.32	0.27 ± 0.39	0.15 ± 0.24	0.02 ± 0.05
	0.00–2.00	0.00–2.00	0.00–1.00	0.00–0.40
		P = 0.035, P = 0.089 for C vs L, P = 0.728 for L vs F, P = 0.096 for F vs C
SE, D	−0.14 ± 0.83	−0.19 ± 0.77	−0.07 ± 0.89	−0.03 ± 0.56
	−3.25–2.13	−3.25–1.38	−3.00–2.13	−1.25–1.38
		P = 0.539, P <0.001 for all subanalysis
Km, D	43.74 ± 1.64	43.88 ± 1.59	43.85 ± 1.69	43.35 ± 1.58
	40.00–47.50	40.00–47.50	40.50–47.25	40.64–45.67
		P = 0.155, P > 0.999 for C vs L, P = 0.510 for L vs F, P = 0.163 for F vs C
Ka, D	−1.40 ± 1.29	−1.71 ± 1.52	−1.18 ± 0.85	−0.76 ± 0.33
	−7.75–0.00	−7.75–0.00	−3.50 – −0.25	−2.00 – −0.17
		P = 0.004, P = 0.188 for C vs L, P = 0.939 for L vs F, P = 0.010 for F vs C
SIA, D	1.28 ± 1.14	1.70 ± 1.27	0.63 ± 0.37	0.86 ± 0.85
	0.09–4.46	0.09–4.46	0.09–1.23	0.09–3.61
		P = 0.004, P = 0.008 for C vs L, P > 0.999 for L vs F, P = 0.045 for F vs C
IOP, mmHg	14.83 ± 2.88	14.98 ± 2.55	14.03 ± 3.54	15.64 ± 2.52
Range	8.00–24.00	10.00–24.00	9.00–19.00	13.00–21.00
		P = 0.154, P = 0.422 for C vs L, P > 0.999 for L vs F, P > 0.999 for F vs C

Notes: ANOVA was used to evaluate whether there is a significant difference between three groups. Bonferroni test was used for post hoc analysis.

Abbreviations: CDVA, corrected distance visual acuity; IOP, intraocular pressure; Ka, keratometric astigmatism; Km, mean keratometry; SE, spherical equivalent; SIA, surgically induced astigmatism vector; UDVA, uncorrected distance visual acuity.

Figure 3 Cumulative histogram of the magnitude of the preoperative corneal and postoperative refractive astigmatism, vertexed to the corneal plane; (A) a conventional 5.5-mm sclerocorneal incision, (B) L-shaped incision, and (C) frown incision.

Table 3 Comparisons of the Postoperative Complications (n=107)

	All Patients (n=107)	Conventional Incision (n=60)	L-Shaped Incision (n=29)	Frown Incision (n=18)
No complication	89 (83.2%)	48 (60.0%) P = 0.223*	27 (93.1%)	14 (77.8%)
Corneal decompensation	0 (0.0%)
Peaked or oval pupil	5 (4.7%)	4 (6.7%) P = 0.362*	0 (0.0%)	1 (5.6%)
Wound leakage	0 (0.0%)
Postoperative hypotomy	0 (0.0%)
Disenclavation	11 (10.3%)	8 (13.3%) P = 0.519*	2 (6.9%)	1 (5.5%)
Cystoid macular edema	5 (4.7%)	3 (5.0%) P = 0.146*	0 (0.0%)	2 (11.1%)
Retinal detachment	0 (0.0%)
Vitreous hemorrhage	0 (0.0%)
Endophthalmitis	0 (0.0%)

Note: *ANOVA was used to evaluate whether there is a significant difference between three groups.

Figure 4 Representative surgical images of the (A) L-shaped incision and (B) frown incision.