Evaluating Safety and Efficacy of a Modified Technique of Scleral Fixation Intraocular Lens Implantation

Not Applicable

• Conditions: Cataract; Aphakia
• Interventions: Procedure: Doubled sutured SFIOL

• Registration Number: NCT04516889
• Lead Sponsor: Chinese University of Hong Kong

Brief Summary

Cataract is the leading cause of blindness globally and cataract surgery with the implantation of intraocular lens (IOL) is the most commonly performed operation worldwide. After removal of the cataract, an IOL is usually implanted within the capsular bag. However, endocapsular implantation of IOL is not always feasible due to inadequate zonular or capsular support, intraoperative posterior capsule rupture, or in primary intracapsular cataract extraction. Predisposing factors including prior ocular trauma, intravitreal injection or intraocular surgery, co-existing ocular comorbidities like chronic uveitis, pseudoexfoliation syndrome, may increase the risk of failure of in-the-bag implantation.

In such situation, the surgeons may consider implanting the IOL in the anterior chamber, ciliary sulcus, or using fixation techniques. In Asian eyes, the anterior chambers are often shallow and placement in anterior chamber may accelerate corneal endothelial cell loss leading to corneal decompensation, or worsen pre-existing glaucoma. Placement in the ciliary sulcus depends on the amount and integrity of the capsular remnant, and inadequate support may result in dislocation of the IOL. In recent years, newer forms of scleral fixation of IOL using glue or glue-less approach, although these procedure appeared to be simpler, the long-term stability of these IOL have not been evaluated against conventional approach with suture fixation. The main limitations of suture fixation technique are related to the sutures either intraoperatively (e.g. entanglement, failure to rotate and bury the suture knot) or postoperatively (breakage, dissolution of suture with time), and the learning curve required for surgeons in training.

Our study aims to study the efficacy and safety of a modified technique of scleral fixation of an intraocular lens in the posterior chamber.

Detailed Description

Not available

Study Timeline

• Status Verified: 2020-08
• Study First Submitted: 2020-08-14
• Study First Submitted QC: 2020-08-14
• Last Update Submitted: 2020-08-14
• Study First Posted: 2020-08-18
• Last Update Posted: 2020-08-18
• Study Start: 2020-10-01
• Primary Completion: 2022-12-31
• Study Completion: 2022-12-31

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 39

Inclusion Criteria

• Adult patients with phacodonesis, lens subluxation, insufficient capsular or zonular support, or surgical aphakia without adequate ciliary sulcus who are listed for scleral fixation intraocular lens implantation.

Exclusion Criteria

• Patients with previous corneal transplantation surgery or undergoing concomitant corneal transplantation at the time of scleral fixation intraocular lens implantation.
• Patients undergoing concomitant vitreoretinal surgery at the time of intraocular lens implantation.
• Monocular patients, or patients whose fellow eye had vision of equal or less than 20/200.
• Patients who could not comprehend the risks and benefits of the surgery and/or the research study, including mentally incapacitated persons.
• Patients with pre-existing macular pathologies including macular oedema, haemorrhage, degeneration or scar.
• Patients with pre-existing iris abnormalities including aniridia, corectopia, extensive anterior synechiae formation resulting in inability to measure the IOL tilting postoperatively.
• Patients with significantly reduced corneal endothelial cell density (of < 1000 cells/mm2) preoperatively which may necessitate a corneal transplantation.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Intervention	Doubled sutured SFIOL	The intervention arm will undergo the modified sutured SFIOL technique with double Prolene sutures instead of a single Prolene suture

Primary Outcome Measures

Name	Time	Method
Proportion of eyes with intraoperative, early (within 1 week) and late (at 12 months) postoperative complications following this modified technique of intraocular lens fixation.	up to 12 months	Complication Rate

Secondary Outcome Measures

Name	Time	Method
Unaided and corrected visual acuities	up to 12 months	Visual acuities
Intraocular lens tilting	up to 12 months	Anterior segment optical coherence tomography
endothelial cell status	up to 12 months	specular microscopy