A novel approach for scleral fixation using Carlevale lens

Abstract

Purpose: To evaluate the surgical outcomes and feasibility of a novel approach for scleral-fixation using a single-piece acrylic foldable Carlevale lens (Soleko). Methods: Eighteen eyes of 18 patients with aphakia, dislocated IOL, subluxated lens, anisometropia, perforated trauma, and retinal detachment who underwent IOL implantation with a Carlevale lens were evaluated. All the patients underwent a standard ophthalmologic examination. Anterior segment (AS)-OCT was used postoperatively to check plugs positioning and IOL tilt. Results: Mean patients age was 73 ± 19 years. Mean follow-up was 11.2 ± 4.1 months. Mean axial length was 23.7 ± 1.65 mm, white-to-white distance was 11.74 ± 0.40 mm, and axial length was 23.67 ± 1.65 mm. Refractive spherical equivalent prediction error was −0.31 ± 0.71D. Mean IOL tilt was 2.2° ± 1.6° and plugs were placed within the sclera. Five patients had aphakia, five in-the-bag IOL subluxation, three in-the-bag IOL luxation, one high residual myopia after previous verisyse implant, one Uveitis-Glaucoma-Hyphema syndrome, one perforating trauma with phacodonesis, one intraocular foreign body and retinal detachment, two lens subluxation. One eye developed cystoid macular edema which disappeared with topical steroids and FANS. No other complications were observed throughout the follow-up. Conclusion: Carlevale lens (Soleko) appears to be a viable option for both anterior and posterior segment surgeons in the management of complex cases providing less challenging maneuvers which lead to a good lens self-centration and minimal risk of haptic rupture and/or dislocation. The lens seems to offer a good compartmentalization between the anterior and posterior chamber reducing the risk of an inflammatory response.

Secondary Sutureless Posterior Chamber Lens Implantation with Two Specifically Designed IOLs: Iris Claw Lens versus Sutureless Trans-Scleral Plugs Fixated Lens

“…In our study, the visual outcomes in the iris claw group (group 1) were comparable with the STSPFL group (group 2) both in the overall cohort of patients and in the subgroup without comorbidities (p = 0.15 and p = 0.08, respectively). Our results are consistent with other studies in the literature reporting the early efficacy of the two surgical techniques [12,13]. Indeed, Barca et al [14] reported similar mean post-operative visual outcomes (0.13 ± 12 logMar) and refractive errors (0.71 ± 1.21) at 8 months of follow up in patients who underwent STSPFL implantation, also reporting the great stability of the lens without cases of IOL dislocation and pseudophacodonesis.…”

“…The use of a PCIOL offers many advantages: it takes place near the original lens position; it is distant from corneal endothelium and angle structures; it provides a good mechanical barrier between the vitreous cavity and anterior chamber [1]. Among the PCIOLs, the iris claw lens is universally considered as a very reliable surgical option, while very recently, the use of sutureless trans-scleral plugs fixated lenses is spreading among surgeons [12,13]. In our study, the visual outcomes in the iris claw group (group 1) were comparable with the STSPFL group (group 2) both in the overall cohort of patients and in the subgroup without comorbidities (p = 0.15 and p = 0.08, respectively).…”

Comparison of two different scleral fixation techniques of posterior chamber Carlevale lens

“…In all surgeries, soft dislocated IOL were cut into 2 pieces and removed through a sclero-corneal tunnel enlarged up to 3.0-mm. When a rigid IOL had to be removed, a wider peritomy was performed and IOL itself was extracted through a curvilinear partial-thickness scleral incision as previously reported [10,13,14] …”

“…The first technique (group 1) has been previously described. [10] A conjunctival peritomy was performed nasally and temporally and a crescent blade was used to perform 2 opposite straight incisions running posteriorly to the limbus for 2.5 mm at 0°and 180°axis (Fig. 2A).…”

“…When a rigid IOL had to be removed, a wider peritomy was performed and IOL itself was extracted through a curvilinear partial-thickness scleral incision as previously reported. [10,13,14] In case of coexisting retinal pathologies or intraoperative complications, a 25-gauge pars plana vitrectomy (PPV) was also performed and trocars were inserted avoiding 0°and 180°axes (Fig. 4B), whereas in cases of surgery limited to the AC, an infusion line was always placed in AC at 6 o'clock position and was used to avoid intraoperative ocular hypotony.…”