Supplementary Material for: Repositioning of In-the-Bag Dislocated Intraocular Lenses. A Randomized Clinical Trial Comparing Two Surgical Methods

Introduction: To evaluate IOL tilt, IOL-induced astigmatism (IIA), refractive change and impact of capsular fibrosis on IOL position after scleral fixation of dislocated IOL using two methods: Ab Externo Scleral Suture Loop Fixation (Group A) and a modification, Embracing the Continuous Curvilinear Capsulorhexis (Group B). Methods: In this prospective randomized clinical trial conducted at St. Erik Eye Hospital, 117 patients with dislocated IOL were randomized to Group A (n = 61) or B (n = 56). Patients with ordinary pseudophakia (n = 60) served as controls. IOL tilt was measured three-dimensionally with anterior segment optical coherence tomography (AS-OCT). Results: The median IOL tilt was similar with both methods (A: 7.8°; B: 8.3°; p=0.51), but higher than in ordinary pseudophakia (5.4°; p<0.001). Both groups showed a myopic shift, p<0.001. In cases without capsular fibrosis, the median IOL tilt was 15.5° in Group A (n = 7) and 7.0° in Group B (n = 5), p=0.19. For each degree of IOL tilt, IIA increased by 0.075D (p<0.001). IOL position could be measured with AS-OCT in all patients given that the IOL was visible in the pupil. Discussion/Conclusion: After IOL fixation surgery, IOL tilt is higher than in normal pseudophakia. A study involving more patients without capsular fibrosis could clarify whether IOL position is better with method B in this subgroup. IOL-induced astigmatism is low, but myopic shift is common. AS-OCT is useful for IOL tilt assessment after IOL fixation surgery. Trial registration number: NCT04150263