. 2021 Jun 11;35(11):2930–2961. doi: 10.1038/s41433-021-01571-5

Table 3.

Studies comparing the use of different IOL implantation techniques in the absence of zonular/capsular support.

Study	Study type and Level of evidence (OCEBM)	IOL techniques compared	No. of eyes	Visual outomes BCVA	Complication rates (%)	Mean follow-up
ACIOL vs. SFIOL
Evereklioglu et al. 2003 [108]	Retrospective comparative study Level 4	ACIOL vs. Sutured SFIOL (10/0 polypropylene)	ACIOL = 73 SFIOL = 51	ACIOL = 20/34.8 ± 45.2 (SD) SFIOL = 20/32 ± 33.7 (SD) (P = 0.718)	ACIOL vs. SFIOL Intraoperative haemorrhage = 6.8% vs. 3.9% Corneal oedema = 9.6% vs. 5.9% CMO = 6.8% vs. 3.9% IOL tilt = 2.8% vs. 5.9% Suture erosion = 0% vs. 7.8%	34 months
Dadeya et al. 2003 [111]	Randomised control trial (RCT) Level 2	ACIOL vs. Sutured SFIOL (8/0 polypropylene)	ACIOL = 30 SFIOL = 30	6/18 or better VA: ACIOL = 36.6% SFIOL = 30%	ACIOL vs. SFIOL CMO = 6.6% vs. 13.2% BK = 6.6% vs. 6.6% Uveitis = 20% vs. 0 Glaucoma = 0% vs. 13.2% RD = 0% vs. 3.3%	3 years
Kwong et al. 2007 [112]	Retrospective comparative study Level 4	ACIOL vs. Sutured SFIOL (10/0 polypropylene)	ACIOL = 46 SFIOL = 36	Mean VA ACIOL vs. SFIOL 0.32 ± 0.31 logMAR vs. 0.49 ± 0.39 logMAR (p = 0.010)	ACIOL vs. SFIOL CMO = 0% vs. 10% VH = 10% vs. 12.5% RD = 0% vs. 10% IOL decentration = 0% vs. 10% Severe uveitis = 3.3% vs. 10%	33.4 ± 17.9 months
Chan et al. 2015 [113]	Retrospective comparative study Level 4	ACIOL vs. Sutured SFIOL (10/0 polypropylene)	ACIOL = 89 SFIOL = 74	Mean VA ACIOL vs. SFIOL = 0.32 ± 0.54 logMAR vs. 0.34 ± 0.21 logMAR (p = 0.73)	ACIOL vs. SFIOL Early: Transient corneal oedema = 66.6% vs. 21.6% VH = 6.7% vs. 12.2% Uveitis = 4.5% vs. 6.8% IOL capture = 1.1% vs. 0 Endophthalmitis = 2.2% vs. 0 Late: BK = 12.4% vs. 10.8% RD = 1.1% vs. 0 CMO = 3.4% vs. 2.7% Persistent raised IOP = 13.5% vs. 23.0%	64.1 ± 36.7 months
Khan et al. 2019 [114]	Retrospective comparative study Level 4	ACIOL vs. Sutured SFIOL (CV-8 Gore-Tex)	ACIOL = 33 SFIOL = 30	ACIOL = 20/50 Snellen SFIOL = 20/46 Snellen	ACIOL vs. SFIOL Transient corneal oedema = 30.3% vs. 6.7% CMO = 9.1% vs. 6.7% VH = 9.1% vs. 10% No IOL dislocations seen in either group	16.7 months
Iris fixation vs. SFIOL
Zheng et al. 2012 [115]	Randomised case series Level 3	Iris claw IOL vs. SFIOL in Marfan’s syndrome (10–0 polypropylene with scleral flaps)	Iris-claw = 32 SFIIOL = 39	Mean VA Iris claw vs. SFIOL 0.22 ± 0.20 logMAR vs. 0.22 ± 0.28 logMAR (p > 0.05)	Iris claw vs. SFIOL IOL decentration = 0% vs. 48.7% Raised IOP = 3.1% vs. 10.3% RD = 0% vs. 5.1% Post-operative transient corneal oedema = 6.3% vs. 5.1% Hyphaema = 0% vs. 2.6%	12 months
Kim et al. 2015 [116]	Retrospective comparative study Level 4	Iris-fixation vs. SFIOL (10/0 polypropylene suture)	Iris-fixation = 44 SFIOL = 35	Iris-fixation = 0.38 ± 0.09 logMAR SFIOL = 0.42 ± 0.09 logMAR (P ≥ 0.05)	Iris fixation vs. SFIOL Intraoperative haemorrhage = 4.5% vs. 0% Endothelial cell loss = 10.9% vs. 12.7% CMO = 0% vs. 2.9% RD = 2.3% vs. 0% IOL dislocation = 13.6% vs. 17.1%	12 months
Jing et al. 2017 [117]	Meta-analysis Level 1	Iris claw lenses vs. SFIOL (meta-analysis) 7 studies included	Iris-claw = 232 SFIOL = 158	No statistical difference between 2 groups in visual outcome data	No difference in RD (p = 0.62) No difference in CMO (p = 0.51) No difference in IOL dislocation (p = 0.31)	15 months (mean of 7 studies)
Madhivanan et al. 2019 [98]	Retrospective comparative study Level 4	Retro-iris claw vs. Sutureless SFIOL (haptic tucked into scleral pockets)	Iris-claw = 48 SFIOL = 56 eyes	VA outcomes (logMAR): 1 month—SFIOL better than iris claw (0.3 vs. 0.7) but did not persist at 1 year (0.3 vs. 0.4)	Iris claw vs. SFIOL: Uveitis = 17% vs 0% RD = 4% vs. 2% Endophthalmitis = 2% vs 0% CMO = 4% vs. 12% Transient hypotony = 19% vs. 25%	12 months
Kelkar et al. 2019 [99]	Retrospective comparative study Level 4	Retro iris claw vs. sutureless SFIOL (flanged technique)	Iris-claw = 90 SFIOL = 60	Mean VA Iris claw vs. SFIOL = 0.36 ± 0.32 logMAR vs. 0.30 ± 0.28 logMAR (p = 0.75)	No significant intraoperative or postoperative complications noted	12 months
Dalby et al. 2019 [25]	Prospective, randomised trial Level 2	Iris claw vs. Sutured SFIOL (10/0 polypropylene)	Iris-claw = 50 SFIOL = 54	Mean VA Iris claw vs. SFIOL 0.22 ± 0.30 logMAR vs. 0.20 ± 0.29 logMAR (p = 0.69)	Iris Claw vs. SFIOL CMO = 15% vs. 12% IOL dislocation = 2.0% vs. 1.8% No cases of endophthalmitis or RD reported	2 years
ACIOL vs. Iris fixated vs SFIOL
Vounotrypidis et al. 2019 [100]	Retrospective comparative study Level 4	ACIOL vs. iris-claw vs. SFIOL	ACIOL = 92 Iris-fixation = 40 SFIOL = 12	ACIOL = 0.45 ± 0.23 logMAR Iris-fixation = 0.42 ± 0.48 logMAR SFIOL = 0.28 ± 0.16 logMAR (P = 0.06)	Post-op AC haemorrhage = Iris-fixation > SFIOL > ACIOL IOL dislocation = SFIOL > Iris-fixation > ACIOL	17 ± 13.6 months
Sutured vs. Sutureless
Ganekal et al. 2012 [101]	Retrospective comparative study Level 4	Sutured SFIOL vs. Fibrin-glue-assisted sutureless SFIOL	Sutured = 25 Sutureless = 25	VA 20/40 or better: Sutured = 88% Sutureless = 84%	Sutured vs. Sutureless Post-operative inflammation = 48% vs. 16% Glaucoma = 40% vs. 16% Overall complications = 56% vs. 28% (P = 0.045)	6 months
Haszcz et al. 2016 [102]	Retrospective comparative study Level 4	Sutured SFIOL (10/0 polypropylene - Hoffman technique) vs. Sutureless SFIOL (Sharioth technique)	Sutured = 31 Sutureless = 11	Sutured = 0.30 logMAR Sutureless = 0.45 logMAR (P = 0.16)	Sutured vs. Sutureless IOL dislocation = 6.4% vs. 0%	14.5 months
Sindal et al. 2016 [103]	Retrospective comparative study Level 4	Sutured SFIOL (10/0 polypropylene) vs. Sutureless SFIOL (haptics tucked into scleral tunnel)	Sutured = 52 Sutureless = 59	Sutured = 0.78 ± 0.45 logMAR Sutureless = 0.66 ± 0.28 logMAR (P = 0.23)	Sutured vs. Sutureless No significant difference in rates of CMO, RD, IOL dislocation. No cases of conjunctival erosion.	18.9 ± 8.7 months
Erdogan et al. 2016 [104]	Retrospective comparative study Level 4	Transcleral SFIOL (TSF) 10–0 polypropylene vs. Intrascleral sutureless SFIOL (ISF) vs. Iris suture fixation (IF)	Transcleral = 13 Intrascleral = 30 Iris fixation = 17	Mean VA TSF vs. ISF vs. IF 0.89 ± 0.84 vs. 0.84 ± 0.42 vs. 0.40 ± 0.30	TSF vs. ISF vs. IF CMO = 7.8% vs. 13.3% vs. 5.8% Transient OHT = 23% vs. 16.7% vs. 5.8% RD = 0 vs. 3.3% vs. 5.8% IOL subluxation/dislocation = 7.8% vs. 3.3% vs. 0%	7 ± 3.7 months
Sinha et al. 2017 [105]	Retrospective comparative study Level 4	Sutured SFIOL (9/0 polypropylene) vs. sutureless intrascleral glued haptic-fixation	Sutured SFIOL = 20 Sutureless SFIOL = 20	Sutured SFIOL = 0.33 ± 0.17 Sutureless SFIOL = 0.22 ± 0.10 (p < 0.05)	Sutured vs. Sutureless Pseudophacodenesis Sutured > Sutureless (p = 0.037) Astigmatism, IOL tilt Sutured>Sutureless (p value not significant) CMO more common in group 1	6 months
Balakrishnan et al. 2018 [106]	Retrospective comparative study Level 4	Glued sutureless SFIOL vs. Sutured SFIOL (4-point fixation with 10–0 polypropylene)	Sutureless = 28 Sutured = 40	Mean VA Sutureless vs. Sutured = 0.42 ± 0.29 logMAR vs. 0.57 ± 0.48 logMAR (p = 0.08)	Sutureless vs. Sutured VH = 17% vs. 5% RD = 3.6% vs. 5% Hypotony = 0% vs. 2.5% Haptic/suture exposure = 3.6% vs. 2.5%	5 months
Li et al. 2018 [107]	Meta-analysis Level 1	Transcleral fixation IOL (TSF) vs. Intrascleral fixation (ISF) vs. Iris claw IOL	TSF = 542 ISF = 107 Iris-claw = 181	No statistical difference between 3 groups in number achieving 20/40 (p > 0.1)	CMO: ISF < TSF; no difference compared to iris claw IOL dislocation: No difference between either group RD: No difference between wither groups Endothelial cell loss: Iris Claw higher risk compared with TSF	Range: 6 months to 34.9 months
Others
Cho et al. 2016 [109]	Retrospective comparative study Level 4	Intrascleral pocket transscleral fixation (TFIOL) vs. Scleral flap TFIOL (10/0 polypropylene)	Intrascleral pocket = 20 Scleral flap TFIOL = 20	VA Intrascleral vs. Scleral flap 0.24 ± 0.31 vs. 0.35 ± 0.28 (p = 0.04)	No complications reported in intrascleral pocket group 5 patients with irritation in the scleral flap group	6 months
Chantarason et al. 2018	Retrospective comparative study Level 4	Reinforced scleral fixation vs. single suture SFIOL (10/0 polypropylene)	Double sutured SFIOL = 26 Single sutured SFIOL = 22	Visual outcomes not statistically significant (0.32 ± 0.17 vs. 0.41 ± 0.19) (p = 0.09)	Early hypotony Single sutured > double sutured IOL tilt and decentration – no statistical difference	12 months
Shin et al. 2020 [24]	Retrospective comparative study Level 4	Transcleral suture fixation: Refixation vs. IOL Exchange (10/0 polypropylene)	Refixation = 40 Exchange = 43	Mean VA Refixation vs. Exchange 0.24 ± 0.25 logMAR vs. 0.59 ± 0.78 logMAR (p = 0.015)	Refixation vs. Exchange IOP increase = 17.5% vs. 4.7% Suture exposure = 2.5% vs. 4.7% Corneal decompensation = 2.5% vs. 7.0% RD = 0% vs. 2.3% CMO = 0% vs. 11.6% IOL dislocation = 0% vs. 2.3% Overall VR complications = 5% vs. 27.9%	6 months

Study

Study type and Level of evidence (OCEBM)

IOL techniques compared

No. of eyes

Visual outomes BCVA

Complication rates (%)

Mean follow-up

ACIOL vs. SFIOL

Evereklioglu et al. 2003 [108]

Retrospective comparative study

Level 4

ACIOL vs. Sutured SFIOL (10/0 polypropylene)

ACIOL = 73

SFIOL = 51

ACIOL = 20/34.8 ± 45.2 (SD)

SFIOL = 20/32 ± 33.7 (SD)

(P = 0.718)

ACIOL vs. SFIOL

Intraoperative haemorrhage = 6.8% vs. 3.9%

Corneal oedema = 9.6% vs. 5.9%

CMO = 6.8% vs. 3.9%

IOL tilt = 2.8% vs. 5.9%

Suture erosion = 0% vs. 7.8%

34 months

Dadeya et al. 2003 [111]

Randomised control trial (RCT)

Level 2

ACIOL vs. Sutured SFIOL (8/0 polypropylene)

ACIOL = 30

SFIOL = 30

6/18 or better VA:

ACIOL = 36.6%

SFIOL = 30%

ACIOL vs. SFIOL

CMO = 6.6% vs. 13.2%

BK = 6.6% vs. 6.6%

Uveitis = 20% vs. 0

Glaucoma = 0% vs. 13.2%

RD = 0% vs. 3.3%

3 years

Kwong et al. 2007 [112]

Retrospective comparative study

Level 4

ACIOL vs. Sutured SFIOL (10/0 polypropylene)

ACIOL = 46

SFIOL = 36

Mean VA

ACIOL vs. SFIOL

0.32 ± 0.31 logMAR vs. 0.49 ± 0.39 logMAR

(p = 0.010)

ACIOL vs. SFIOL

CMO = 0% vs. 10%

VH = 10% vs. 12.5%

RD = 0% vs. 10%

IOL decentration = 0% vs. 10%

Severe uveitis = 3.3% vs. 10%

33.4 ± 17.9 months

Chan et al. 2015 [113]

Retrospective comparative study

Level 4

ACIOL vs. Sutured SFIOL (10/0 polypropylene)

ACIOL = 89

SFIOL = 74

Mean VA

ACIOL vs. SFIOL = 0.32 ± 0.54 logMAR vs. 0.34 ± 0.21 logMAR

(p = 0.73)

ACIOL vs. SFIOL

Early:

Transient corneal oedema = 66.6% vs. 21.6%

VH = 6.7% vs. 12.2%

Uveitis = 4.5% vs. 6.8%

IOL capture = 1.1% vs. 0

Endophthalmitis = 2.2% vs. 0

Late:

BK = 12.4% vs. 10.8%

RD = 1.1% vs. 0

CMO = 3.4% vs. 2.7%

Persistent raised IOP = 13.5% vs. 23.0%

64.1 ± 36.7 months

Khan et al. 2019 [114]

Retrospective comparative study

Level 4

ACIOL vs. Sutured SFIOL (CV-8 Gore-Tex)

ACIOL = 33

SFIOL = 30

ACIOL = 20/50 Snellen

SFIOL = 20/46 Snellen

ACIOL vs. SFIOL

Transient corneal oedema = 30.3% vs. 6.7%

CMO = 9.1% vs. 6.7%

VH = 9.1% vs. 10%

No IOL dislocations seen in either group

16.7 months

Iris fixation vs. SFIOL

Zheng et al. 2012 [115]

Randomised case series

Level 3

Iris claw IOL vs. SFIOL in Marfan’s syndrome

(10–0 polypropylene with scleral flaps)

Iris-claw = 32

SFIIOL = 39

Mean VA

Iris claw vs. SFIOL

0.22 ± 0.20 logMAR vs. 0.22 ± 0.28 logMAR

(p > 0.05)

Iris claw vs. SFIOL

IOL decentration = 0% vs. 48.7%

Raised IOP = 3.1% vs. 10.3%

RD = 0% vs. 5.1%

Post-operative transient corneal oedema = 6.3% vs. 5.1%

Hyphaema = 0% vs. 2.6%

12 months

Kim et al. 2015 [116]

Retrospective comparative study

Level 4

Iris-fixation vs. SFIOL (10/0 polypropylene suture)

Iris-fixation = 44

SFIOL = 35

Iris-fixation = 0.38 ± 0.09 logMAR

SFIOL = 0.42 ± 0.09 logMAR

(P ≥ 0.05)

Iris fixation vs. SFIOL

Intraoperative haemorrhage = 4.5% vs. 0%

Endothelial cell loss = 10.9% vs. 12.7%

CMO = 0% vs. 2.9%

RD = 2.3% vs. 0%

IOL dislocation = 13.6% vs. 17.1%

12 months

Jing et al. 2017 [117]

Meta-analysis

Level 1

Iris claw lenses vs. SFIOL (meta-analysis)

7 studies included

Iris-claw = 232

SFIOL = 158

No statistical difference between 2 groups in visual outcome data

No difference in RD (p = 0.62)

No difference in CMO (p = 0.51)

No difference in IOL dislocation (p = 0.31)

15 months (mean of 7 studies)

Madhivanan et al. 2019 [98]

Retrospective comparative study

Level 4

Retro-iris claw vs. Sutureless SFIOL (haptic tucked into scleral pockets)

Iris-claw = 48

SFIOL = 56 eyes

VA outcomes (logMAR):

1 month—SFIOL better than iris claw (0.3 vs. 0.7) but did not persist at 1 year (0.3 vs. 0.4)

Iris claw vs. SFIOL:

Uveitis = 17% vs 0%

RD = 4% vs. 2%

Endophthalmitis = 2% vs 0%

CMO = 4% vs. 12%

Transient hypotony = 19% vs. 25%

12 months

Kelkar et al. 2019 [99]

Retrospective comparative study

Level 4

Retro iris claw vs. sutureless SFIOL (flanged technique)

Iris-claw = 90

SFIOL = 60

Mean VA

Iris claw vs. SFIOL

= 0.36 ± 0.32 logMAR vs. 0.30 ± 0.28 logMAR

(p = 0.75)

No significant intraoperative or postoperative complications noted

12 months

Dalby et al. 2019 [25]

Prospective, randomised trial

Level 2

Iris claw vs. Sutured SFIOL (10/0 polypropylene)

Iris-claw = 50

SFIOL = 54

Mean VA

Iris claw vs. SFIOL

0.22 ± 0.30 logMAR vs. 0.20 ± 0.29 logMAR

(p = 0.69)

Iris Claw vs. SFIOL

CMO = 15% vs. 12%

IOL dislocation = 2.0% vs. 1.8%

No cases of endophthalmitis or RD reported

2 years

ACIOL vs. Iris fixated vs SFIOL

Vounotrypidis et al. 2019 [100]

Retrospective comparative study

Level 4

ACIOL vs. iris-claw vs. SFIOL

ACIOL = 92

Iris-fixation = 40

SFIOL = 12

ACIOL = 0.45 ± 0.23 logMAR

Iris-fixation = 0.42 ± 0.48 logMAR

SFIOL = 0.28 ± 0.16 logMAR

(P = 0.06)

Post-op AC haemorrhage = Iris-fixation > SFIOL > ACIOL

IOL dislocation = SFIOL > Iris-fixation > ACIOL

17 ± 13.6 months

Sutured vs. Sutureless

Ganekal et al. 2012 [101]

Retrospective comparative study

Level 4

Sutured SFIOL vs. Fibrin-glue-assisted sutureless SFIOL

Sutured = 25

Sutureless = 25

VA 20/40 or better:

Sutured = 88%

Sutureless = 84%

Sutured vs. Sutureless

Post-operative inflammation = 48% vs. 16%

Glaucoma = 40% vs. 16%

Overall complications = 56% vs. 28% (P = 0.045)

6 months

Haszcz et al. 2016 [102]

Retrospective comparative study

Level 4

Sutured SFIOL (10/0 polypropylene - Hoffman technique) vs. Sutureless SFIOL (Sharioth technique)

Sutured = 31

Sutureless = 11

Sutured = 0.30 logMAR

Sutureless = 0.45 logMAR

(P = 0.16)

Sutured vs. Sutureless

IOL dislocation = 6.4% vs. 0%

14.5 months

Sindal et al. 2016 [103]

Retrospective comparative study

Level 4

Sutured SFIOL (10/0 polypropylene) vs. Sutureless SFIOL (haptics tucked into scleral tunnel)

Sutured = 52

Sutureless = 59

Sutured = 0.78 ± 0.45 logMAR

Sutureless = 0.66 ± 0.28 logMAR

(P = 0.23)

Sutured vs. Sutureless

No significant difference in rates of CMO, RD, IOL dislocation. No cases of conjunctival erosion.

18.9 ± 8.7 months

Erdogan et al. 2016 [104]

Retrospective comparative study

Level 4

Transcleral SFIOL (TSF) 10–0 polypropylene vs. Intrascleral sutureless SFIOL (ISF) vs. Iris suture fixation (IF)

Transcleral = 13

Intrascleral = 30

Iris fixation = 17

Mean VA

TSF vs. ISF vs. IF

0.89 ± 0.84 vs. 0.84 ± 0.42 vs. 0.40 ± 0.30

TSF vs. ISF vs. IF

CMO = 7.8% vs. 13.3% vs. 5.8%

Transient OHT = 23% vs. 16.7% vs. 5.8%

RD = 0 vs. 3.3% vs. 5.8%

IOL subluxation/dislocation = 7.8% vs. 3.3% vs. 0%

7 ± 3.7 months

Sinha et al. 2017 [105]

Retrospective comparative study

Level 4

Sutured SFIOL (9/0 polypropylene) vs. sutureless intrascleral glued haptic-fixation

Sutured SFIOL = 20

Sutureless SFIOL = 20

Sutured SFIOL = 0.33 ± 0.17

Sutureless SFIOL = 0.22 ± 0.10

(p < 0.05)

Sutured vs. Sutureless

Pseudophacodenesis Sutured > Sutureless

(p = 0.037)

Astigmatism, IOL tilt Sutured>Sutureless

(p value not significant)

CMO more common in group 1

6 months

Balakrishnan et al. 2018 [106]

Retrospective comparative study

Level 4

Glued sutureless SFIOL vs. Sutured SFIOL (4-point fixation with 10–0 polypropylene)

Sutureless = 28

Sutured = 40

Mean VA

Sutureless vs. Sutured = 0.42 ± 0.29 logMAR vs. 0.57 ± 0.48 logMAR

(p = 0.08)

Sutureless vs. Sutured

VH = 17% vs. 5%

RD = 3.6% vs. 5%

Hypotony = 0% vs. 2.5%

Haptic/suture exposure = 3.6% vs. 2.5%

5 months

Li et al. 2018 [107]

Meta-analysis

Level 1

Transcleral fixation IOL (TSF) vs. Intrascleral fixation (ISF) vs. Iris claw IOL

TSF = 542

ISF = 107

Iris-claw = 181

No statistical difference between 3 groups in number achieving 20/40

(p > 0.1)

CMO:

ISF < TSF; no difference compared to iris claw

IOL dislocation:

No difference between either group

RD:

No difference between wither groups

Endothelial cell loss:

Iris Claw higher risk compared with TSF

Range: 6 months to 34.9 months

Others

Cho et al. 2016 [109]

Retrospective comparative study

Level 4

Intrascleral pocket transscleral fixation (TFIOL) vs. Scleral flap TFIOL

(10/0 polypropylene)

Intrascleral pocket = 20

Scleral flap TFIOL = 20

Intrascleral vs. Scleral flap

0.24 ± 0.31 vs. 0.35 ± 0.28

(p = 0.04)

No complications reported in intrascleral pocket group

5 patients with irritation in the scleral flap group

6 months

Chantarason et al. 2018

Retrospective comparative study

Level 4

Reinforced scleral fixation vs. single suture SFIOL

(10/0 polypropylene)

Double sutured SFIOL = 26

Single sutured SFIOL = 22

Visual outcomes not statistically significant

(0.32 ± 0.17 vs. 0.41 ± 0.19)

(p = 0.09)

Early hypotony Single sutured > double sutured

IOL tilt and decentration – no statistical difference

12 months

Shin et al. 2020 [24]

Retrospective comparative study

Level 4

Transcleral suture fixation:

Refixation vs. IOL Exchange

(10/0 polypropylene)

Refixation = 40

Exchange = 43

Mean VA

Refixation vs. Exchange

0.24 ± 0.25 logMAR vs. 0.59 ± 0.78 logMAR

(p = 0.015)

Refixation vs. Exchange

IOP increase = 17.5% vs. 4.7%

Suture exposure = 2.5% vs. 4.7%

Corneal decompensation = 2.5% vs. 7.0%

RD = 0% vs. 2.3%

CMO = 0% vs. 11.6%

IOL dislocation = 0% vs. 2.3%

Overall VR complications = 5% vs. 27.9%

6 months

OCEBM Oxford centre for evidence-based medicine: Levels of Evidence, PMMA Polymethylmethacrylate, VH vitreous haemorrhage, RD retinal detachment, BK bullous keratopathy, IOP intraocular pressure, IOL intraocular lens, CMO cystoid macular oedema, OHT ocular hypertension.