Modified Sutureless Intrascleral Fixation Technique for Secondary Intraocular Lens Implantation

Abstract

Background/Purpose: To demonstrate possible complications of a new intraocular lens for sutureless secondary scleral implantation and modifications of the surgical technique to optimize outcomes. Methods: A retrospective study of 16 eyes (16 patients) who underwent a secondary intraocular lens implantation using the Carlevale intraocular lens (Soleko, Italy) with two anchor haptics for intrascleral implantation (mean follow-up 2.2 months). Results: The visual acuity did not improve statistically significantly postoperatively (P = 0.601). Seven (44%) patients suffered from postoperative hypotonia (intraocular pressure <5 mmHg) during the first three postoperative days. Conclusion: Owing to the early postoperative hypotony, we decided to modify the surgical technique. We present several suggestions to optimize the technique and outcome such as positioning the sclerotomies at the 2 and 8 o'clock positions, using 27 G trocars alone and suturing the frown incisions using self-resorbing sutures.

Scleral Fixation of Carlevale Intraocular Lens

“…The mean change in BCVA, which was reported in 13 studies with a total of 550 eyes, is presented in Figure 2A. 7,8,10–17,20,21,23 The pooled results showed a significant improvement in BCVA in patients who underwent SSF with Carlevale IOL (WMD = 0.38, 95% CI: 0.30–0.46, P <0.001; heterogeneity [I 2 ] =52.02%). Funnel plot and Egger regression revealed no publication bias with an Egger coefficient of −0.88 (95% CI: −2.55–0.77, Prob > |t| = 0.25) (see Figures 1 and 2 , Supplemental Digital Content 3 , http://links.lww.com/IAE/C19).…”

“…We assessed three retrospective observational comparative studies 9,18,22 and 14 case series studies. 7,8,10–17,19–21,23 Among the observational comparative studies, two studies 9,22 compared two different SSF techniques using either the three-piece IOL or the iris claw lens and the Carlevale IOL and only one compared the surgical outcomes of two different scleral fixation techniques using only the Carlevale IOL. 18…”

“…When required, all patients underwent complete 23-, 25-, or 27-gauge pars plana vitrectomy. Surgical variations were introduced by Januschowski et al 7 and Caporossi et al, 20 who created two vitrectomy ports as lens plug fixation sites to reduce the wounds' number, and transient postoperative hypotension and VH, and operating times. Furthermore, Danese et al 21 conducted the whole surgical technique with only three transconjunctival sclerotomies and a corneal tunnel without performing limbal-based scleral flaps.…”

“…However, the mean change in BCVA was reported at different follow-ups across the studies. Indeed, the median last follow-up BCVA across five studies was 6 months, 7,8,13,14,20 and only five studies evaluated the BCVA for up to 24 months. 10,15–17,21 Vaiano et al 11 reported BCVA at 3, 6, and 12 months and Barca et al 23 at 4 and 8 months, whereas Sidiropoulos et al 12 at 1, 6, 12, and 24 months after surgery.…”

“…The IOL is designed to be suspended in the posterior chamber through two transscleral plugs, and its implantation results in excellent lens stability. 7–23…”