1 Year Surgical Outcomes and Safety of Combined Trans Pars Plana Vitrectomy with Iris Fixated Posterior Chamber Intraocular Lens for Subluxated Intraocular Lens and Cataracts

Figures & data

Table 1 Overall Demographic and Ocular Characteristics of Patients with Subluxated Cataract/Intraocular Lens (IOL) in the Study at Baseline

	All	Subluxated Cataract (Median or n/IQR or %)	Subluxated IOL (Median or n/IQR or %)	p
	N = 103	N = 32	N = 71
Median age at original cataract diagnosis, years (IQR)	63 (58–69)	57 (51–63)	66 (59–72)	0.07
Ethnicity
Chinese	73 (70.9)	27 (84.4)	46 (64.8)	0.58
Malay	24 (23.3)	4 (12.5)	20 (28.2)
Indian	6 (5.8)	1 (3.1)	5 (7.0)
Gender				0.65
Female	54 (52.4)	18 (56.2)	26 (36.6)
Male	49 (47.6)	14 (43.8)	35 (49.4)
Type of original cataract operation
Phacoemulsification	–	–	34 (47.9)
ECCE	–	–	3 (4.2)
ICCE	–	–	1 (1.4)
Unknown	–	–	33 (46.5)
Complicated original cataract surgery				–
PCR with no nucleus drop	5 (6.8)	–	5 (7.0)
PCR with nucleus drop	39 (37.9)	–	39 (54.9)
Unknown	–	–	27 (38.1)
Identifiable predisposing factors for subluxation				0.005
Trauma	3 (2.9)	1 (3.1)	2 (2.8)
Previous TPPV	6 (5.8)	0 (0)	6 (8.5)
Pseudoexfoliation syndrome	2 (1.9)	2 (6.3)	0 (0)
Marfan’s syndrome	1 (0.9)	1 (3.1)	0 (0)
Retinitis pigmentosa	1 (0.9)	0 (0)	1 (1.4)
Years after original cataract extraction before subluxation/median (IQR)	–	–	6 (0.5–40)
Classification of Subluxation				<0.001
Dislocation into Anterior Chamber	9 (8.7)	7 (21.8)	3 (4.2)
Pseudophacodonesis	36 (35.0)	18 (56.3)	20 (28.2)
Posterior dislocation into the anterior vitreous cavity	16 (15.5)	4 (12.5)	12 (16.9)
Trap door-like dislocation	12 (11.7)	2 (6.3)	9 (12.6)
Dropped on the retina	30 (29.1)	1 (31.3)	28 (38.4)
Preoperative logMAR BCVA (median/IQR)	0.9 (0–2.5)	0.9 (0–2.5)	0.9 (0–2.0)	0.20
Axial Length, mm (median/IQR)	24.6 (21.9–24.4)	24.1 (22.2–27.5)	25.2 (21.9–24.4)	0.72

Abbreviations: IQR, interquartile range; ECCE, extracapsular cataract extraction; ICCE, intracapsular cataract extraction; PCR, posterior capsule rupture; TPPV, trans pars plana vitrectomy; BCVA, best corrected visual acuity.

Table 2 Post-Operative Surgical Outcomes and Complications of Subluxated Cataracts and IOLs

	All	Subluxated Cataract (Median or n/IQR or %)	Subluxated IOL (Median or n/IQR or %)	p
Post-operative Month 1
No. of eyes with follow-up	85 (82.5)	22 (68.8)	63 (88.7)
LogMAR BCVA /median (IQR)	0.2 (0–1.8)	0.3 (0–1.8)	0.2 (0–1.8)	0.29
Sphere (D) /median (IQR)	0 (−6.3–2.0)	0 (−0.9–0)	−0.3 (−3.8–2.0)	0.66
Cyl (D) /median (IQR)	−1 (−3.5–0.8)	−0.8 (−3.5–0.8)	−1.3 (−3.5–0)	0.21
SE (D) /median (range)	−0.9 (−4.8–1.9)	−0.6 (−1.8 to −0.4)	−1.0 (−4.8–1.4)	0.32
IOL status				0.34
Stable	84 (98.9)	22 (100.0)	62 (98.4)
Complications				0.74
IOP spike >24mm Hg	13 (15.3)	4 (18.2)	9 (14.3)
Persistent inflammation	3 (3.5)	1 (4.5)	2 (3.2)
CMO	1 (1.2)	0 (0)	1 (1.6)
Hyphema/VH	2 (2.4)	0 (0)	2 (3.2)
Retinal detachment	1 (1.2)	1 (4.5)	0 (0)
Tilted IOL	1 (1.2)	0 (0)	1 (1.6)
Optic capture	2 (2.4)	1 (4.5)	1 (1.6)
Post-operative Month 12
No. of eyes with follow-up	48 (46.6)	16 (50.0)	32 (45.1)
LogMAR BCVA/median (IQR)	0.2 (0–1.9)	0.2 (0–1.9)	0.2 (0–1.8)	0.70
Sphere (D) /median (IQR)	0 (−2.5–1.8)	0.1 (−0.5–0.8)	0 (−2.5–1.8)	0.71
Cyl (D)/median (IQR)	−1.5 (−4.5 to −0.3)	−1.8 (−2.5 to −1.23)	−1.4 (−4.5 to −0.3)	0.76
SE (D)	−0.7 (−2.6–0.1)	−1.0 (−1.3–0.1)	−0.6 (−2.9–0)	0.58
IOL status				0.37
Stable	46 (95.8)	15 (93.8)	31 (96.9)
Subluxated	2 (4.2)	1 (6.3)	1 (3.1)
Complications				0.33
IOP spike >24mm Hg	6 (12.5)	2 (12.5)	4 (12.5)
Persistent inflammation	1 (2.1)	1 (6.3)	0 (0)
CMO	2 (4.2)	1 (6.3)	1 (3.1)
Hyphema/VH	3 (6.3)	1 (6.3)	2 (6.3)
PBK	2 (4.2)	0 (0)	3 (9.4)
Retinal detachment	1 (2.1)	1 (6.3)	0 (0)
Optic capture	0 (0)	0 (0)	1 (3.1)
Tilted IOL	1 (2.1)	0 (0)	1 (3.1)
No. with logMAR BCVA ≤ 0.30	37 (77.1)	13 (81.2)	24 (75.0)	0.56
No. of eyes with improvement in BCVA	38 (79.2)	13 (81.2)	25 (78.1)	0.47

Abbreviations: BCVA, best corrected visual acuity; IQR, interquartile range; D, dioptre; IOL, intraocular lens; IOP, intraocular pressure; CMO, cystoid macular oedema; VH, vitreous haemorrhage; SE, spherical equivalent; PBK, pseudophakic bullous keratopathy.

Table 3 Comparison of Refractive Outcomes at Month 12

	All	Subluxated Cataract (Median or n/IQR or %)	Subluxated IOL (Median or n/IQR or %)	p
	N = 48	N = 16	N = 32
Predicted Refraction (SE)	−0.2 (−2.2–0.2)	−0.2 (−0.6–0)	−0.20 (−2.2–0.2)	0.45
Postoperative subjective refraction (SE)	−0.7 (−2.6–0.1)	−0.6 (−2.9 - −0.2)	−1.0 (−1.3–0.1)	0.58
Refractive prediction error (SE)	−0.5 (−2.2–0.2)	−0.4 (−1.0- −0.1)	−0.8 (−1.4–0.2)	0.39
Median absolute error (SE)	0.3 (0.1–0.5)	0.2 (0.0–0.3)	0.3 (0.1–0.5)	0.28
Number within ± 0.50 SE [n (%)]	32 (66.7)	12 (75.0)	20 (62.5)	0.32
Number within ± 1.0 SE [n (%)]	44 (91.6)	15 (93.8)	29 (90.6)	0.29

Abbreviations: SE, spherical equivalent; IQR, interquartile range.