27-gauge microincision vitrectomy surgery-assisted scleral fixation of intraocular lens: An anterior segment optical coherence tomography-guided study.

PURPOSE: To evaluate the outcomes of 27-gauge (27G) microincision vitrectomy surgery (MIVS)-assisted scleral fixation of intraocular lenses (SFIOLs) using anterior segment optical coherence tomography (AS-OCT). The study assesses postoperative intraocular lens (IOL) tilt, decentration, and iris to IOL distance and their impact on visual and refractive outcomes.

METHODS

This retrospective study included 36 patients undergoing 27G MIVS-assisted SFIOL implantation. Preoperative data, including best-corrected visual acuity (BCVA), intraocular pressure (IOP), endothelial cell count, and surgical indications, were recorded. Postoperatively, BCVA, IOP, and endothelial cell count were assessed at 3 months. Additionally, postoperative AS-OCT was performed to assess IOL tilt, decentration, and distance of the IOL from the posterior iris surface. Surgical complications were documented.

RESULTS

The mean IOL tilt was 3.58 ± 0.57 degrees, IOL decentration was 0.22 ± 0.47 mm, and IOL to posterior iris distance was 0.76 ± 0.66 mm. At three months, BCVA significantly improved from 0.85 ± 0.53 log MAR to 0.38 ± 0.38 log MAR ( P = 0.03). Hyperopic shift (manifest refractive spherical equivalent [MRSE]: +1.14 ± 0.62 D) correlated strongly with increased distance of IOL from the posterior iris surface. Complications included early postoperative IOL tilt ( n = 4, requiring refixation), vitreous hemorrhage ( n = 3, resolving spontaneously), and choroidal detachment ( n = 2, resolving with corticosteroids).

CONCLUSIONS

The 27G MIVS-assisted SFIOL technique demonstrates favorable outcomes with minimal IOL tilt and decentration. The technique offers a safe and effective alternative for scleral fixation, optimizing surgical efficiency and patient outcomes.