Is scleral fixation a safe procedure for intraocular lens implantation?

Purpose: No consensus currently exists on the optimal method for intraocula r (IOL) implantation without capsular support. We evaluated the outcome and angiographic findings of eyes that underwent the implantation of scleral f ixated IOLs. Methods: Iris and retinal fluorescein angiography were perform ed in 13 eyes that had received posterior chamber IOL implantation with scl eral fixation. Follow-up examinations also assessed visual acuity (VA), int raocular pressure (IOP), IOL decentration and complications related to the procedure. Results: Mean visual acuity was 0.29 preoperatively and 0.71 pos toperatively after a mean follow-up of 14.2 months. A best corrected visual acuity of 0.5 or better was obtained in 12 eyes. Iris fluorescein angiogra phy did not show major vascular abnormalities. Retinal angiography showed 5 cases of macular edema. In 6 eyes light-induced retinal lesions occurred. Cellophane maculopathy was disclosed in 4 eyes. Macular edema was associate d with photic injury in 4 cases and with cellophane maculopathy in 2 cases. Mean postoperative visual acuity was 0.6 in eyes with macular edema and 0. 88 in eyes without (SD 0.18; range 0.5-1.0). Four of 5 eyes with macular ed ema had a postoperative visual acuity of 0.5 or better. There was no eviden ce of persistent IOP elevation or IOL decentration. No serious complication s were recorded during surgery. Conclusions: Transscleral fixation of poste rior chamber IOLs provides adequate visual acuity in most patients. Macular edema was frequently associated with the procedure. Although this complica tion was a cause of low visual recovery after implantation, the majority of eyes with macular edema achieved a visual acuity of 0.5 or better. Light-i nduced retinal injury was a permanent complication.