Risk factors for and management of pupillary intraocular lens capture after intraocular lens transscleral fixation.

PURPOSE: To analyze risk factors and management of pupillary intraocular lens (IOL) capture after IOL transscleral fixation.

SETTING: Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea.

DESIGN: Retrospective case series.

METHODS: A chart review was performed of patients who had transscleral fixation of IOLs between January 1, 2012, and December 31, 2013. Eyes were divided into 2 groups depending on whether the IOL was pupillary captured. Perioperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), spherical equivalent (SE) with refraction, axial length (AL), and total follow-up time were compared between the 2 groups. Ultrasound biomicroscopy images were used to analyze iris morphology and IOL position.

RESULTS: The chart review identified 138 patients, 112 patients of whom were included in this analysis. The preoperative and final mean CDVA, IOP, SE, AL, and most iris morphologic parameters were not significantly different between the 2 groups. In the pupillary capture IOL group, the mean age of patients with was younger, the anterior chamber depth (ACD) was narrower, and the rate of reverse pupillary block was higher (P = .003, P = .03, and P = .016, respectively). Intraocular lens decentration in the captured group was significantly larger (P = .002). Multiple logistic regression analysis showed that ACD, reverse pupillary block, and main decentration were associated with pupillary capture of the IOL.

CONCLUSIONS: Pupillary capture of an IOL occurred more in eyes with reverse pupillary block and poor IOL positioning. Accordingly, laser iridotomy must be considered for treatment.