Safety and Efficacy of Toric Intraocular Lens Sclerocorneal Fixation in the Absence of Capsular Support and Avitria

Currently, implantation of toric IOLs is the main correction method of regular corneal astigmatism in patients with cataracts. However,

weakness of the lens zonules and lack of capsular support are negative factors for the use of toric IOLs. The question of the possibility of toric IOL implantation in these clinical situations remains open, especially in the state of avitria. 

Purpose: to evaluate the safety and efficacy of toric IOL sclerocorneal fixation in the absence of capsular support and avitria status. Materials and methods: a prospective study of the results of a toric IOL sclerocorneal fixation (n = 12) was conducted. All patients underwent a combined surgery, including subtotal vitrectomy and a toric IOL sclerocorneal fixation of. In addition to the standard ophthalmologic examination, ultrasound B-scanning (VuMax HD Sonomed Inc. USA), keratotopography (Pentacam HR, Oculus, Germany), optical coherence tomography (RTVue XR Avanti Optovue, USA) were performed; the features of the surgical course, duration of surgery, and the presence of intraand postoperative complications were analyzed. The follow-up period was 12 months after surgery. 

Results. Average surgical time was 57 minutes [44, 76]. No significant complications were observed during surgery. According to ultrasound biomicroscopy data 12 months after surgery, a clinically insignificant tilt of the IOL (from 5 to 7 degrees) was detected in five cases. Optical coherence tomography did not reveal any signs of macular edema in any case. There were no cases of flange cutting and externalization, or manifestations of infectious complications. The values of uncorrected distance visual acuity before surgery were 0.05 [0.01; 0.12], after surgery — 0.32 [0.20; 0.60], the best corrected visual acuity before surgery was on average 0.12 [0.05; 0.40], after surgery — 0.40 [0.35; 0.50]. 

Conclusion. Combined surgery, including vitrectomy and sclerocorneal fixation of a toric IOL, is an effective and safe method for correcting aphakia and corneal astigmatism in cases where capsular support is absent.

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