Scleral fixation of Carlevale intraocular lens: A new tool in correcting aphakia with no capsular support

Purpose: To report the clinical outcomes of the use of a novel specially designed scleral fixated intraocular lens, the Carlevale intraocular lens (carlevale IOL, Soleko, Italy) for the correction of aphakia in the absence of capsular support of variable etiology. Methods: This retrospective, non-comparative study included 169 eyes of 169 consecutive patients who underwent 3-port pars plana vitrectomy and scleral fixation on Carlevale IOL. Inclusion criteria were at least 6 months’ follow-up period, patients > 18 years old who underwent vitrectomy and Carlevale IOL placement for aphakia and inadequate capsular support Results: The median follow up period of 9 months (range 6–18 months). Mean post-operative BCVA at the last follow-up visit was 20/25 (0.09 ± 0.1 LogMAR), improving from a mean baseline BCVA of 20/80 (0.58 ± 0.49 LogMAR), a statistically significant change ( p = 0.0001). Regarding the post-operative complications, a transient rise in the IOP was observed in 28 patients (16.5%) and mild vitreous hemorrhage was observed in the immediate post-operative period in eight eyes (4.7%) and it spontaneously resolved within 3 weeks. All patients demonstrated good IOL position at the end of the follow-up without IOL capture. None of the patients required re-operation. Conlcusion: The present study represents the largest to date in evaluating the use of carlevale IOL in patients with aphakia and inadequate capsular support. The technique is safe and provides excellent post-operative IOL fixation without IOL capture in any of the patients studied.

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Outcomes and Complications of Concurrent Pars Plana Vitrectomy and Scleral-Fixated Intraocular Lens Placement Using Gore-Tex Suture

Journal of VitreoRetinal Diseases ◽

10.1177/2474126419895691 ◽

2019 ◽

Vol 4 (2) ◽

pp. 119-124

Author(s):

H. Russell Day ◽

Alia K. Durrani ◽

Stephen J. Kim ◽

Shriji Patel

Keyword(s):

Visual Acuity ◽

Postoperative Complications ◽

Intraocular Lens ◽

Pars Plana Vitrectomy ◽

Vitreous Hemorrhage ◽

Posterior Chamber ◽

Pars Plana ◽

The Mean ◽

Scleral Fixated Intraocular Lens

Purpose: The authors aim to describe the visual outcomes and postoperative complications of concurrent pars plana vitrectomy and scleral-fixated intraocular lens (IOL) placement using Gore-Tex suture. Methods: A retrospective review of medical records was performed on 27 eyes of 27 patients undergoing concurrent pars plana vitrectomy and scleral-fixated IOL with Gore-Tex suture. Outcome measures were change in preoperative and postoperative visual acuity, final manifest refraction, and incidence of intraoperative and postoperative complications. Results: The mean age was 69.2 ± 11.3 years; there were 16 male patients (59%). The duration of follow-up ranged from 33 to 576 days with a mean of 200 ± 143 days. All patients received Bausch + Lomb Akreos AO60 IOL. The overall mean best-corrected visual acuity in Snellen equivalent improved from 20/276 preoperatively to 20/44 postoperatively ( P < .001). The mean postoperative manifest spherical equivalent refraction was –0.35 ± 1.34 diopters (D). Seventy-five percent of eyes were ± 1.0 D of target refraction. Postoperative complications included corneal edema (26.0%), ocular hypertension (25.9%), hypotony (7.4%), cystoid macular edema (7.4%), vitreous hemorrhage (7.4%), and hyphema (3.7%). No cases of suture breakage, IOL dislocation, retinal detachment, or uveitis–glaucoma–hyphema syndrome were identified. Conclusions: The use of Gore-Tex suture for posterior chamber IOL fixation resulted in favorable outcomes. No suture-related complications occurred during the follow-up period. Final refraction in this setting is typically within ± 1.0 D of target.

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Modified Flapless and Sutureless Technique of Scleral Fixation of Intraocular Lens in the Management of Dislocation of Crystalline Lens Following Closed Globe Injury

10.21203/rs.3.rs-230197/v1 ◽

2021 ◽

Author(s):

Naresh Babu Kannan ◽

Sagnik Sen ◽

Gauri Khare ◽

Obuli Ramachandran ◽

Kim Ramasamy

Keyword(s):

Intraocular Lens ◽

Demographic Data ◽

Crystalline Lens ◽

Modified Technique ◽

Prospective Longitudinal Study ◽

Scleral Fixation ◽

Sutureless Technique ◽

Pars Plana ◽

Prospective Longitudinal

Abstract Purpose To evaluate the outcomes of management of subluxation of lens following closed globe injury with a modified technique of scleral fixation of intraocular lens (SFIOL). Methods This prospective longitudinal study evaluated eyes with subluxation of crystalline lens which underwent combined pars plana vitrectomy (PPV), lensectomy (PPL) along with a sutureless and flapless technique of SFIOL implantation. We documented clinico-demographic data of all eyes at baseline and final anatomical and visual outcomes at 6 months after the surgery. Results We evaluated 113 eyes of 113 subjects with a mean age of 51.5 +- 15.7 years. 48.7% of eyes had a partial subluxation of lens from patellar fossa, while 51.3% of eyes had complete subluxation. After 6 months, the baseline visual acuity of 1.40 +- 0.66 logMAR (Snellen equivalent = 6/180) increased to 0.23 +- 0.27 (Snellen equivalent = 6/9) (p < 0.001). Eyes having VA < 6/36 reduced from 79.6% at baseline to 4.4% at final follow-up (p < 0.001). Eyes having VA > = 6/12 increased from 8.8–85.8% (p < 0.001). The proportion of eyes having raised intraocular pressure reduced from 20.4–1.8% at final follow-up (p < 0.001). The most common cause of subnormal visual gain was macular degeneration secondary to commotio retinae. Conclusion Subluxation of lens is a common entity faced by ophthalmologists across the world. Lensectomy with PPV and SFIOL is an effective method of refractive rehabilitation for subluxation eyes following closed globe injury. Visual prognosis may still depend upon the initial insult on the retina.

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Scleral Fixation of Posterior Chamber Intraocular Lenses Using Gore-Tex Suture: Clinical Outcomes From a Single Institution

Journal of VitreoRetinal Diseases ◽

10.1177/2474126418791701 ◽

2018 ◽

Vol 2 (5) ◽

pp. 276-281 ◽

Cited By ~ 3

Author(s):

Benjamin Botsford ◽

Andrew M. Williams ◽

Ian P. Conner ◽

Andrew W. Eller ◽

Joseph N. Martel

Keyword(s):

Postoperative Complications ◽

Clinical Outcomes ◽

Vitreous Hemorrhage ◽

Retrospective Chart Review ◽

Crystalline Lens ◽

Intraocular Lenses ◽

Posterior Chamber ◽

Scleral Fixation ◽

Pars Plana

Purpose: The purpose of this article is to examine the clinical outcomes of scleral fixation of intraocular lenses (IOLs) using Gore-Tex suture at our institution. Methods: A retrospective chart review was conducted of patients who underwent scleral fixation of an IOL with Gore-Tex suture with concurrent pars plana vitrectomy. Intraoperative and postoperative complications were assessed. Results: Seventy-four eyes of 74 patients were included with a mean follow-up interval of 210 days (range, 33–720 days). The mean best-corrected visual acuity improved from 20/480 (1.38 logarithm of the minimum angle of resolution [logMAR]) preoperatively to 20/78 (0.59 logMAR) postoperatively ( P < .001). Indications included dislocated lens implant (42), aphakia without capsular support (18), and subluxation of crystalline lens (14). Bausch and Lomb Akreos AO60 IOL was implanted in 52 eyes, Alcon CZ70BD in 15, and Bausch and Lomb enVista MX60 in 6. Postoperative complications included temporary ocular hypertension in 9 eyes (12%), temporary hypotony in 7 (9%), cystoid macular edema in 3 eyes (4%), corneal decompensation in 2 eyes (3%), IOL dislocation requiring exchange in 1 case (1.4%), vitreous hemorrhage in 2 cases (3%), and retinal detachment in 2 cases (3%). There were no cases of postoperative suture breakage or erosion, endophthalmitis, or hyphema. Conclusions: The use of Gore-Tex suture in scleral fixation of posterior chamber IOLs was well tolerated at a mean follow-up interval of 210 days. There were no suture-related complications.

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Sutureless Scleral-Fixated Intraocular Lens Implantation for Refractive Rehabilitation in Eyes With Spherophakia

Journal of VitreoRetinal Diseases ◽

10.1177/2474126420936187 ◽

2020 ◽

Vol 4 (6) ◽

pp. 479-483

Author(s):

Naresh Babu Kannan ◽

Sagnik Sen ◽

Sourav Damodaran ◽

Meri Debbarma ◽

Renu P. Rajan ◽

...

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Intraocular Lens Implantation ◽

Visual Disability ◽

Lens Implantation ◽

Minimum Angle ◽

Pars Plana ◽

Preoperative Status ◽

Scleral Fixated Intraocular Lens

Purpose: Spherophakia is a rare, debilitating congenital ocular disorder. Methods: This institution-based, retrospective, interventional study evaluated medical records of 16 patients with spherophakia with a median age of 19.5 years. Twenty-six eyes underwent scleral-fixated intraocular lens implantation. The technique involved 2 parallel-to-limbus scleral tunnels fashioned using a microincision vitrectomy blade, followed by lensectomy, core vitrectomy, externalization of haptics through 2 separate diametrically opposite sclerotomies, and tucking in of the haptics into the tunnels. Anterior and posterior segment examination, visual acuity, and intraocular pressure (IOP) were noted at baseline and final follow-up. Results: Baseline best-corrected visual acuity (BCVA) of all eyes was 0.49 ± 0.51 logarithm of the minimum angle of resolution (logMAR) (Snellen equivalent, 6/18). BCVA of more than 6/60 was present in 28 of 32 (87.5%) eyes, and 13 of 26 (50%) eyes that were operated on had a baseline BCVA of more than 6/18. Postoperative BCVA in 26 eyes improved from 0.43 ± 0.32 logMAR to 0.19 ± 0.21 logMAR (Snellen equivalent, 6/9) ( P = .002). Postoperative BCVA was more than 6/18 in 20 of 26 (76.9%) operated-on eyes ( P = .046), and all eyes had a final BCVA of more than 6/60. In 20 of 26 (76.9%) eyes, BCVA improved from preoperative status. Postoperatively, spherical equivalent improved from –9.55 ± 5.17 diopters to –0.29 ± 1.45 diopters ( P < .001). Apart from 2 patients with Marfan syndrome, 1 with Weill-Marchesani syndrome, and 1 with homocystinuria, the remaining patients had isolated spherophakia. Six eyes presented with an IOP greater than 21 mm Hg, and 50% of these eyes had a final IOP that decreased to less than 15 mm Hg after lensectomy. Conclusions: Lensectomy with pars plana vitrectomy and scleral-fixated intraocular lens is an effective method of refractive rehabilitation for patients with spherophakia presenting with visual disability.

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Scleral Fixation of Intraocular Lens with Ab Interno Technique

Journal of Nepal Medical Association ◽

10.31729/jnma.3148 ◽

2017 ◽

Vol 56 (206) ◽

Author(s):

Nanda Kumari Gurung ◽

Roshija Rijal ◽

Bel Bhahadur Thapa ◽

Shanti Gurung

Keyword(s):

Surgical Management ◽

Intraocular Lens ◽

Safe Procedure ◽

Scleral Fixation ◽

Scleral Tunnel ◽

Long Term Follow Up ◽

Prolene Suture ◽

Age Range ◽

Capsular Support

Introduction: Implantation of scleral fixation intraocular lens for the surgical management of aphakia cases without capsular support is a safe procedure.Methods: Prospective study was carried out at Lumbini Eye Institute, Bhairahawa. A total of 32 patients underwent scleral fixation intraocular lens implantation within a period of two years from February 2014 to February 2016.Results: The age range was from 15 to 79 years; mean age was 47.56±20.16 SD. Among them 14 (43.75%) were male and 18 (56.25%) were female. The follow-up lasted for 24 months. The postoperative characteristics of the patients are listed in the tables below.Conclusions: SFIOL for the surgical management of aphakia in the absence of capsular support is a safe procedure. The long-term follow-up is needed for an accurate evaluation of outcomes.Keywords: double armed prolene suture; intraocular pressure; scleral fixation intraocular lens; scleral tunnel. [PubMed]

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Clinical outcomes of combined pars plana vitrectomy and scleral fixation of the intraocular lens with a suspension bridge method in eyes with aphakia or insufficient capsular support

Acta Ophthalmologica ◽

10.1111/aos.14758 ◽

2021 ◽

Author(s):

Hun Jin Choi ◽

Oh Woong Kwon ◽

Suk Ho Byeon ◽

Ji Hun Song

Keyword(s):

Clinical Outcomes ◽

Intraocular Lens ◽

Pars Plana Vitrectomy ◽

Suspension Bridge ◽

Scleral Fixation ◽

Bridge Method ◽

Pars Plana ◽

Capsular Support

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Recurrent Intraocular Lens Dislocation in a Patient with Familial Ectopia Lentis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094545 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4545

Author(s):

Tomasz K. Wilczyński ◽

Alfred Niewiem ◽

Rafał Leszczyński ◽

Katarzyna Michalska-Małecka

Keyword(s):

Intraocular Lens ◽

Pars Plana Vitrectomy ◽

Vision Loss ◽

Silicone Oil ◽

Single Case ◽

Recurrent Dislocation ◽

Ectopia Lentis ◽

Pars Plana ◽

The Right

A 36-year-old patient presented to the hospital with recurrent dislocation of the intraocular lens (IOL). The patient with the diagnosis of familial ectopia lentis was first operated on for crystalline lens subluxation in the left eye in 2007 and in the right eye in 2009. In both eyes, lens extraction with anterior vitrectomy and transscleral fixation of a rigid IOL was performed. In 2011, the IOL in the right eye luxated into the vitreous cavity due to ocular trauma. The patient underwent a pars plana vitrectomy with the IOL resuturation to the sclera. Seven years later, a spontaneous vision loss in the right eye was caused by a retinal detachment. The pars plana vitrectomy with silicone oil tamponade and a consequential oil removal three months later were performed in 2018. The follow-up examination revealed recurrent IOL dislocation in the same eye. Due to a history of previous suture-related complications a decision was made to remove the subluxated rigid polymethyl-methacrylate (PMMA) IOL and fixate to sclera a sutureless SOLEKO FIL SSF Carlevale lens. The purpose of this report is to present a single case of a 36-year-old patient who was presented to the hospital with recurrent dislocation of the intraocular lens. In a three-month follow-up period, a good anatomical and functional outcome was finally obtained with transscleral sutureless intraocular lens. This lens is an option worth considering especially in a young patient with a long life expectancy and physically active.

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Comparison of outcomes of scleral fixation with and without pars plana vitrectomy for the treatment of dislocated intraocular lens

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-017-3802-y ◽

2017 ◽

Vol 255 (12) ◽

pp. 2503-2509 ◽

Cited By ~ 1

Author(s):

Seung Yong Choi ◽

You Sook Hwang ◽

Mirinae Kim ◽

Soon Il Choi ◽

Young-Hoon Park

Keyword(s):

Intraocular Lens ◽

Pars Plana Vitrectomy ◽

Scleral Fixation ◽

Pars Plana

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Long-Term Stability of Sutured Scleral Fixation of a Posterior Chamber Intraocular Lens With 10-0 Polypropylene for More Than 30 Years

Journal of VitreoRetinal Diseases ◽

10.1177/2474126420978870 ◽

2021 ◽

pp. 247412642097887

Author(s):

Gregg T. Kokame ◽

Tarin T. Tanji ◽

Jase N. Omizo

Keyword(s):

Intraocular Lens ◽

Posterior Chamber ◽

Scleral Flap ◽

Scleral Fixation ◽

Polypropylene Suture ◽

Long Term Stability ◽

Posterior Chamber Intraocular Lens ◽

Polypropylene Sutures

Purpose: We report the longest follow-up to our knowledge of stable scleral fixation of a posterior chamber intraocular lens (PC IOL) with 10-0 polypropylene sutures. Methods: A retrospective review is presented of a case with more than 30 years’ follow-up after performing sutured scleral fixation with 10-0 polypropylene suture using 2 sutures tied together under a scleral flap. One suture was a cow-hitch looped around the haptic, and the other suture was passed through the sclera to create the scleral fixation. Results: The scleral fixation with 10-0 polypropylene suture knots for both haptics of the PC IOL allowed central optic positioning with excellent vision for more than 30 years without suture breakage. Conclusions: Polypropylene sutures for scleral fixation of PC IOLs remained stable for more than 30 years with central positioning of the PC IOL, without exposure of the fixation suture knots through the conjunctiva, and without suture breakage.

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