Ab externo 4-point scleral fixation of posterior chamber intraocular lenses

Purpose: To evaluate the results of ab externo 4-point scleral fixation of posterior chamber intraocular lenses (PC IOLs) as a primary or secondary pr ocedure. Setting: Aravind Eye Hospital, Madurai, India. Methods: This retrospective study comprised 25 patients: 17 aphakic and 8 w ith traumatic subluxated lenses. The subluxated cataracts were removed intr acapsularly. All patients had ab externo 4-point flapless scleral fixation of a PC IOL. Preoperative status, intraoperative details, and postoperative outcome were analyzed. Results: Mean follow-up was 8.02 months (range 6 to 26 months). The preoper ative findings included sector iridectomy (n = 6), peripheral anterior syne chias (n = 5), corneal scar (n = 2), vitreous hemorrhage (n = 2), traumatic angle recession (n = 1), retinitis pigmentosa (n = 1), primary open-angle glaucoma (n =:1), and macular pigmentary mottling (n = 1). There were no in traoperative problems related to scleral fixation. Postoperative complicati ons and findings included cystoid macular edema (CME) (n = 2), uveitis (n = 1), and a healed macular choroidal tear (n = 1). No patient had suture exp osure, IOL tilt/decentration, or infection. Twenty-two patients (88.0%) had a visual acuity of 6/12 or better at final follow-up. The cause of poor vi sual recovery in 3 patients included pre-existing macular degeneration, hea led macular choroidal tear, and CME in 1 patient each. Conclusion: Four-point scleral fixation is a simple technique that in this series of 25 patients was not associated with major intraoperative or posto perative complications and gave satisfactory visual results.