Clinical Outcomes of Intrascleral Fixation of Intraocular Lens Compared to Ciliary Sulcus Implantation and Transscleral Fixation

Purpose: To compare the clinical outcomes of intrascleral fixation of the three-piece intraocular lenses (IOLs) 2.5 mm posteriorto the limbus with ciliary sulcus implantation and transscleral fixation 2.5 mm posterior to the limbus. Methods: Sixty-five eyes of 65 patients who underwent ciliary sulcus implantation or transscleral or intrascleral fixation ofthe AMO Sensar AR40e IOL were retrospectively reviewed. The postoperative refractive prediction error, back-calculatedeffective lens position (ELP), corrected distance visual acuity (CDVA), and postoperative residual cylinder were compared. Results: There were significant differences in the median (interquartile range) postoperative refractive prediction error (diopters[D]) among the three groups (p < 0.001): for ciliary sulcus implantation (33 eyes), −0.89 D (−1.21 to −0.56 D); for transscleralfixation (10 eyes), −0.40 D (−0.78 to −0.22 D); and for intrascleral fixation (22 eyes), 0.01 D (−0.28 to 0.34 D). Significantdifferences (p < 0.001) were observed in the median back-calculated ELP: for ciliary sulcus implantation, 4.35 mm (3.95 to4.55 mm); for transscleral fixation, 4.51 mm (4.34 to 4.76 mm); and for intrascleral fixation, 4.90 mm (4.56 to 5.35 mm). Therewere no differences in the median postoperative CDVA (0, 0.10, and 0 logarithm of the minimum angle of resolution, respectively;p = 0.083) and the residual cylinder (−0.75, −1.50, and −0.63 D, respectively; p = 0.074) among three groups. Conclusions: Intrascleral fixation showed no myopic shift and the most posterior lens position, while ciliary sulcus implantationinduced the greatest myopic shift and the most anterior lens position. However, there was no significant difference in thepostoperative CDVA or astigmatism among the eyes with different IOL insertion methods, demonstrating good IOL stabilityand vision outcomes.