To compare the clinical features and long-term treatment outcomes of patients undergoing secondary intraocular lens (IOL) surgery with scleral-fixated (SFIOL) versus retropupillary iris-claw IOL (RPICIOL).
Consecutive patients treated between June 2014 and December 2019 at two tertiary centres were retrospectively reviewed. The primary outcome was the best-corrected visual acuity (BCVA). Secondary outcomes included factors associated with significant corneal endothelial injury and postoperative redislocation.
This study included 395 eyes undergoing surgery with SFIOL (237 eyes, 60%) or RPICIOL (158 eyes, 40%), with no differences in baseline BCVA (P=0.76) or endothelial cell density(ECD) (P=0.39). Compared to the SFIOL group, the RPICIOL group had faster visual recovery (postoperative month 1, 20/37 vs. 20/46, P=0.005) sustained to over 36 months (P=0.034), favourable absolute prediction errors (within 0.5D, 67.3% vs. 54.9%, P=0.027), and shorter operation times (52.7 vs. 60.9 minutes, P=0.015). There was no difference in ECD after 12 months (P=0.282). Over a mean follow-up duration of 33 months (152 cases >3 years, 38.5%), the SFIOL group experienced more cases of tilted/decentred IOLs (14 vs. 1, P=0.006), suture exposure (7 vs. 0, P=0.045), and redislocation (17.7% vs. 10.1%, P1D (P=0.029).
RPICIOL appears to be a safe and effective surgical option for secondary IOL surgery over a long-term follow-up, comparing favourably against conventional SFIOL.

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