Corneal endothelial cell damage after scleral fixation of intraocular lens surgery

Jpn J Ophthalmol. 2022 Jan;66(1):68-73. doi: 10.1007/s10384-021-00884-y. Epub 2021 Nov 9.


Purpose: To analyze corneal endothelial cell damage after scleral fixation of intraocular lens (SFIOL) surgery.

Study design: Retrospective study.

Methods: Medical records of consecutive eyes undergoing SFIOL surgery performed by a single surgeon were reviewed between January 2011 and June 2019. The patients were classified into three groups according to surgical methods: Group I, re-fixating the existing intraocular lens (IOL) or fixating a new IOL in an aphakic eye; Group II, removing the existing IOL and fixating a new IOL; and Group III, phacoemulsification and fixating a new IOL simultaneously. Preoperative and postoperative specular microscopy (SM) status were compared. Changes in SM were compared among the three groups.

Results: Ninety-four eyes were included. Thirty-four eyes in Group I, 39 in Group II, and 21 in Group III. The endothelial cell density (ECD) loss in Group I was 1.5%, less than the ECD loss of 14.3% (p < 0.001) in Group II and 15.4% (p = 0.005), in Group III. In no eye was there an ECD decrease to < 1000/mm2 following the surgical procedure.

Conclusions: ECD loss was related to IOL removal or phacoemulsification rather than SFIOL surgery. SFIOL using the existing IOL should be considered preferential in eyes with low ECD and dislocated IOL.

Keywords: Aphakia; Dislocated intraocular lens; Endothelial cell density; Phacoemulsification; Scleral fixation.

MeSH terms

  • Corneal Endothelial Cell Loss* / diagnosis
  • Corneal Endothelial Cell Loss* / etiology
  • Humans
  • Lens Implantation, Intraocular
  • Lenses, Intraocular*
  • Postoperative Complications
  • Retrospective Studies
  • Sclera / surgery
  • Visual Acuity