Outcomes of Transscleral Two-Point Fixation Versus Closed Continuous-Loop Four-Point Fixation of Intraocular Lens in Subluxated Lens Secondary to Marfan Syndrome

INTRODUCTION: To compare the outcome of two different transscleral fixation approaches for posterior chamber intraocular lens (IOL) implantation, a two-point fixation of the Sensar (Allergan) or CZ70BD (Alcon) IOL and a four-point fixation of the Akreos Adapt (Bausch & Lomb) foldable IOL, for treatment of subluxated lenses in Marfan syndrome (MFS). METHODS: Fifty-three eyes of 33 consecutive patients with subluxated lenses secondary to MFS were studied. Eighteen patients with MFS (30 eyes) received two-point fixation of the Sensar (16 patients, 26 eyes) or CZ70BD (2 patients, 4 eyes) IOL, and 15 patients with MFS (23 eyes) received four-point fixation of the Akreos Adapt IOL. Preoperative and postoperative ophthalmologic examinations were performed. A primary outcome measure of postoperative complication was studied. RESULTS: The mean preoperative best corrected visual acuity (BCVA) in the two-point group was 0.68 ± 0.38 logarithm of the minimum angle of resolution (logMAR), and it improved to 0.30 ± 0.32 logMAR at the final follow-up (p < 0.05). The mean preoperative BCVA in the four-point group was 0.68 ± 0.45 logMAR, and it improved to 0.28 ± 0.28 logMAR at the final follow-up (p < 0.05). The BCVA results did not differ significantly between groups. The intraocular pressure was increased at the final follow-up in the two-point group (p < 0.05). Transscleral two-point fixation of IOL has relatively high incidences of pupillary capture of the IOL. CONCLUSION: The closed continuous-loop transscleral four-point fixation of the Akreos Adapt foldable IOL is more suitable than two-point fixation of a two-haptic IOL in treating subluxated lenses due to MFS.