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Abstract：
Objectives: This study compared long-term surgical outcomes of the scleral flap versus scleral pocket technique for sutureless intrascleral one-piece intraocular lens (IOL) fixation. Methods: A retrospective comparative study was conducted at a single center, involving consecutive patients undergoing sutureless intrascleral one-piece IOL implantation, between January 2020 and May 2022. Eyes were divided into two groups based on the surgical technique: group 1 underwent scleral flap (n = 64), and group 2 received scleral pocket technique (n = 59). Visual acuity, refractive outcomes, and complications were assessed over a minimum 24-month follow-up period. Results: Both groups showed improvements in best-corrected visual acuity (BCVA), increasing from 0.84 ± 0.56 logMAR at baseline to 0.39 ± 0.23 logMAR (p = 0.042) at 24 months in group 1 and from 0.91 ± 0.63 logMAR at baseline to 0.45 ± 0.38 logMAR (p = 0.039) at 24 months in group 2. No significant differences in BCVA were observed between the groups at baseline (p = 0.991), 12 (p = 0.496) and 24 months (p = 0.557). Mean spherical equivalent (-0.73 ± 1.32 D in group 1 and -0.92 ± 0.99 D in group 2, p = 0.447), refractive prediction error (-0.21 ± 1.1 D in group 1 and -0.35 ± 1.8 D in group 2, p = 0.377), and surgically induced astigmatism (0.74 ± 0.89 D in group 1 and 0.85 ± 0.76 in group 2, p = 0.651) were comparable between the two groups. An IOL tilt of 5.5 ± 1.8 and 5.8 ± 2.0 degrees (p = 0.867) and an IOL decentration of 0.41 ± 0.21 mm and 0.29 ± 0.11 mm (p = 0.955) were obtained, respectively, in group 1 and group 2 at 24 months. Mean endothelial cell density remained stable at 24 months in both groups (p = 0.832 in group 1 and p = 0.443 in group 2), and it was 1747.20 ± 588.03 cells/mm2 in group 1 and 1883.71 ± 621.29 cells/mm2 in group 2 (p = 0.327) at baseline, 1545.36 ± 442.3 cells/mm2 in group 1 and 1417.44 ± 623.40 cells/mm2 in group 2 (p = 0.483) at 24 months. No cases of endophthalmitis were observed. Conclusions: The scleral pocket technique for sutureless intrascleral one-piece IOL fixation is comparable to the traditional scleral flap technique in terms of long-term visual outcomes and safety. The scleral pocket technique offers a simplified approach and a viable option even for less experienced surgeons.
摘要：
目的：这项研究比较了巩膜瓣与巩膜袋技术用于无缝线巩膜内一件式人工晶状体（IOL）固定的长期手术效果。方法：在单个中心进行回顾性比较研究，涉及连续接受无缝线巩膜内单片IOL植入的患者，2020年1月至2022年5月。根据手术技术将眼睛分为两组：第1组接受巩膜瓣（n=64），第2组接受巩膜袋技术（n=59）。视敏度,屈光结果，在至少24个月的随访期内评估并发症.结果：两组均显示最佳矫正视力（BCVA）的改善，第1组从基线时的0.84±0.56logMAR增加至24个月时的0.39±0.23logMAR(p=0.042),第2组从基线时的0.91±0.63logMAR增加至24个月时的0.45±0.38logMAR(p=0.039).两组基线时BCVA无显著差异（p=0.991），12个月（p=0.496）和24个月（p=0.557）。平均球面当量（组1为-0.73±1.32D，组2为-0.92±0.99D，p=0.447），屈光预测误差（组1为-0.21±1.1D，组2为-0.35±1.8D，p=0.377），手术引起的散光（1组0.74±0.89D，2组0.85±0.76，p=0.651）在两组之间具有可比性。获得5.5±1.8和5.8±2.0度的IOL倾斜（p=0.867）和0.41±0.21mm和0.29±0.11mm（p=0.955）的IOL偏心，分别,在第1组和第2组24个月。两组平均内皮细胞密度在24个月时保持稳定（第1组p=0.832，第2组p=0.443），在基线时，第1组为1747.20±588.03细胞/mm2，第2组为1883.71±621.29细胞/mm2（p=0.327），在24个月时，第1组1545.36±442.3个细胞/mm2，第2组1417.44±623.40个细胞/mm2（p=0.483）。未观察到眼内炎病例。结论：巩膜袋技术用于无缝线巩膜内一件式IOL固定，在长期视觉效果和安全性方面与传统巩膜瓣技术相当。巩膜袋技术提供了一种简化的方法和可行的选择，即使对于经验不足的外科医生也是如此。
