Refractive Outcomes after Pars Plana Vitrectomy and Scleral Fixated Intraocular Lens with Gore-Tex Suture

Purpose: To evaluate refractive outcomes after combined pars plana vitrectomy (PPV) and scleral fixation of an intraocular lens (IOL) using Gore-Tex suture. Design: Retrospective cohort study. Participants: Fifty-five eyes from 53 patients who underwent PPV with a Gore-Tex sutured IOL from June 2013 through December 2017. Methods: Patients who underwent combined PPV and scleral fixation of an IOL with Gore-Tex suture were identified. All eyes underwent scleral fixation of either an Akreos A060 or enVista MX60 IOL and were fixated either 2 mm or 3 mm posterior to the limbus. Postoperative manifest refractions were performed at least 3 months after surgery and were compared with preoperative predicted target refraction based on in-the-bag IOL calculations. Subgroup analyses based on sclerotomy placement and IOL models were performed. Main Outcome Measures: Postoperative manifest refraction and difference with sclerotomy placement and IOL model. Results: The mean postoperative spherical equivalent (SEQ) was -0.99 +/- 1.00 diopters (D). The mean difference in SEQ (Delta SEQ) from preoperative predicted target was -0.64 +/- 1.00 D. The IOL was fixated 2 mm posterior to the limbus in 14 eyes and 3 mm in 41 eyes. Within these 2 subgroups, the mean postoperative SEQ was -1.53 +/- 1.35 D for fixation 2 mm posterior to the limbus and -0.82 +/- 0.83 D for fixation 3 mm posterior to the limbus (P = 0.09). The mean Delta SEQ was -0.43 +/- 0.71 D for fixation 3 mm posterior to the limbus and -1.35 +/- 1.32 D for fixation 2 mm posterior to the limbus (P = 0.03). The mean amount of surgically induced astigmatism in the overall cohort was 0.77 +/- 0.65 D. The mean Delta SEQ and induced astigmatism were similar between IOL models. Conclusions: After combined PPV and Gore-Texesutured IOL implantation, mean postoperative refractive outcomes were more myopic when the IOL was fixated 2 mm from the limbus compared with 3 mm from the limbus. No significant difference was found between IOL models. Based on these results, future implant power calculations may be adjusted to approximate preoperative target refraction more accurately. (C) 2019 by the American Academy of Ophthalmology