Scleral Fixation of Carlevale Intraocular Lens in Children: A Novel Tool in Correcting Aphakia With No Capsular Support

Abstract

BACKGROUND AND OBJECTIVE: To report the clinical outcomes of the use of a novel, specially designed, scleral-fixated intraocular lens (IOL) for the correction of aphakia in the absence of capsular support of variable etiology in children. PATIENTS AND METHODS: This is a retrospective, noncomparative, interventional case series of five eyes of five consecutive patients who underwent three-port pars plana vitrectomy and scleral fixation of the IOL. Inclusion criteria were at least 6 months of follow-up in children who underwent vitrectomy and IOL placement for aphakia and inadequate capsular support. Patients were excluded from the analysis if there was a previous open globe injury or any other ocular comorbidity such as macular pathology or previous surgery for retinal detachment, glaucoma, corneal transplantation, or strabismus. RESULTS: The median follow-up period was 9 months (range: 7–13 months). The median age was 8 years (range: 2–10 years), and the male-to-female ratio was 5 to 0. Mean postoperative best-corrected visual acuity (VA) at the last follow-up visit was 20/32 (0.26 ± 0.32 logMAR [mean ± standard deviation]), improving from a mean baseline uncorrected VA of 20/800 (1.6 ± 0.7 logMAR), a statistically significant change ( P = .003). The uncorrected postoperative VA was 20/63 (0.54 ± 0.37 logMAR). No significant postoperative complications were noted and all patients had good IOL position at the end of the follow-up without IOL capture. The mean tilt in four eyes (the 2-year-old was excluded from the analysis) was 2.1 ± 1.9 degrees. None of the patients required reoperation. CONLCUSIONS: The present study represents the first to date in evaluating the use of a scleral-fixated IOL in patients with aphakia and in pediatric patients with inadequate capsular support. The technique is safe and provides excellent postoperative IOL fixation without IOL capture in any of the patients studied. [ Ophthalmic Surg Lasers Imaging Retina . 2021;52:94–101.]

Surgical Management of Paediatric Aphakia in the Absence of Sufficient Capsular Support

“…Mild IOL decentration ( n = 2), pigmentary deposits on the IOL ( n = 3), irregular peaked pupil due to a vitreous strand ( n = 1) and visible haptic through the conjunctiva in a child with Marfan syndrome were reported. Finally, a recent study retrospectively evaluated the use of Carlevale IOL in five paediatric eyes with aphakia and insufficient capsular support [ 19 ]. The Carlevale IOL is a novel foldable, acrylic, one-piece lens with T-shaped haptics, specifically designed for scleral fixation without sutures [ 20 ].…”

“…The Carlevale IOL is a novel foldable, acrylic, one-piece lens with T-shaped haptics, specifically designed for scleral fixation without sutures [ 20 ]. In the technique presented by Gotzaridis et al, the Carlevale IOL was inserted into the anterior chamber after three-port pars-plana vitrectomy [ 19 ]. The leading T-shaped haptic was then grabbed with 25G intraocular forceps under the scleral flaps and expressed through the sclerotomy.…”

“…Visual results of the flanged intrascleral IOL fixation (Yamane technique) agree with those presented above, since postoperative BCVA improved in 50% of the cases or remained stable. Significant visual acuity improvement has been reported with Carlevale IOLs as well, with a mean postoperative BCVA at 0.26 ± 0.32 logMAR after a median follow-up period of 9 months (range 7–13 months) [ 19 ]. Although all these sutureless methods appear promising, they have not been widely performed in children and their long-term results need to be investigated.…”

Peripheral Intravascular Catheter-Assisted Sutureless Scleral Fixation of Three-Piece Intraocular Lenses: A Novel Technique

“…Reprint requests: Andrea Govetto MD, PhD, Ophthalmology Department, VR Division Ospedale di Circolo e Fondazione Macchi Varese, Italy; e-mail: a.govetto@gmail.com fixation. 2,6 The technique is relatively simpler if compared with the Yamane, and the anatomical and functional results are satisfactory. 2,6,7 However, long-term conjunctival erosion because of harpoons friction and externalization has been described.…”

“…2,6 The technique is relatively simpler if compared with the Yamane, and the anatomical and functional results are satisfactory. 2,6,7 However, long-term conjunctival erosion because of harpoons friction and externalization has been described. 8 The aim of this pilot report is to describe the functional and anatomical results of an alternative scleral fixation surgical technique that may guarantee similar outcomes and some advantages if compared with the Yamane technique and the Carlevale lens.…”