Factors Influencing Visual and Refractive Outcomes for Scleral-Sutured Intraocular Lenses

Purpose: To identify variables associated with successful surgical outcomes in eyes receiving a scleral-sutured intraocular lens (IOL). Methods: Eyes of patients ages ≥18 years at time of IOL insertion and with ≥1 follow-up visit were included. Eyes with concurrent ophthalmic procedures other than pars plana vitrectomy or with follow-up at outside institutions were excluded. Demographic, biometric, preoperative, intraoperative, and 3-month postoperative variables were collected from electronic medical records. Success following scleral-sutured IOL placement was defined primarily as vision improvement (visual acuity 20/40 or better or ≥3 Snellen lines of improvement) and secondarily as refractive improvement (within 0.5 diopters of refractive target) at 3 months postoperatively. Comparisons of success vs failure groups included t tests, Wilcoxon signed-rank tests, χ ² tests, and Fisher exact tests. Using a random forest model, associated variables were identified and incorporated into multivariable logistic regression to determine the likelihood of vision and refractive success, expressed as odds ratios (ORs) with 95% CIs. P values less than or equal to .05 were considered significant. Results: A total of 182 eyes received a scleral-sutured IOL. At 3 months postoperatively, the median number of complications was 0, and the improvement in logMAR visual acuity was 37%. In total, 72% of eyes met vision success criteria. Worse preoperative vision was associated with higher odds of 3-month postoperative vision success (OR, 3.92, 95% CI, 2.03–8.66; P < .001), whereas having more preexisting ocular conditions compared with fewer preexisting ocular conditions (OR, 0.55, 95% CI, 0.37–0.78; P = .001) and use of CZ70BD lenses compared with use of Akreos AO60 lenses (OR, 0.23, 95% CI, 0.07–0.72; P = .01) were associated with lower odds of vision success. In total, 24% of eyes met refractive success criteria. Lower power IOLs were associated with refractive success (mean IOL power, 16.4 diopters vs 18.0 diopters in success vs failure groups; P = .05), showing a positive correlation (R = 0.3, P = .002). Conclusions: This study suggests that preoperative ocular status and intraoperative considerations, like lens brand, may affect patient outcomes. Ultimately, this may guide surgical planning and postoperative expectations for visual and refractive potential after scleral-sutured IOL implantation.