Abstract
Purpose To evaluate the clinical outcome and safety profile of a new sutureless scleral fixation (SSF) technique using a single-piece foldable acrylic Carlevale intraocular lens. Methods In this case study, 27 eyes of 27 patients were implanted with an SSF single-piece IOL because of inadequate or absent capsular support. The hand-shake technique used during surgery was combined with the creation of scleral pockets in order to secure the IOL haptics. The BCVA was evaluated in the 1st and 6th month in every patient and in the 12th and 24th months, when possible. Also, we evaluated the improvement achieved in spherical equivalent values from baseline to the 6th month after the procedure. Intraoperative and postoperative complications were assessed. Results The mean age was 69.1 ± 14.9 years, and the mean follow-up was 13.6 ± 4.8 months. Indications of scleral-fixated IOL included dislocated posterior chamber IOL (40.7%), dislocated anterior chamber IOL (11.1%), subluxated traumatic cataract (18.5%), subluxated nontraumatic cataract (18.5%), and aphakia (11.1%). Concurrent PPV was performed on eight of the eyes (32%). The mean preoperative logMAR BCVA increased from 0.85 ± 0.59 baseline to 0.44 ± 0.30 one month after surgery (p < 0.01) and 0.36 ± 0.34 (p < 0.003) six months after surgery. The baseline refractive status expressed in SE was 4.3 ± 6.4 D, and the postoperative status was −0.5 ± 0.99 D. Postoperative complications included vitreous hemorrhage (7.4%), hypotony (7.4%), transient IOP elevation (3.7%), and postoperative cystoid macular oedema (3.7%). The IOL was very well centered and stable in every case during the follow-up period. Conclusion The use of the SSF technique with implantation of a single-piece foldable acrylic Carlevale IOL seems to be a safe and effective alternative method that provides good preliminary results in cases where capsular support is inadequate or absent. Long-term stability results would be required to evaluate the benefit of this novel surgical approach in order to compare it with other existing methods.
Highlights
Cataract surgery with intraocular lens (IOL) implantation is currently one of the most frequent and successful surgical procedures [1]
In the pars plana vitrectomy (PPV) group, mean best corrected visual acuity (BCVA) increased from 1.02 ± 0.60 LogMar baseline to 0.65 ± 0.37 within the first month (Wilcoxon test, p < 0.01) and to 0.47 ± 0.30 (Wilcoxon test, p < 0.005) within six months. e refractive spherical equivalent changed significantly from 3.6 ± 12 D to −0.59 ± 0.98 D within six months (p < 0.01 paired samples t-test). e mean corneal endothelial cell density decreased from 2553 ± 205 cells/mm2 to 2453 ± 200 cells/ mm2 (Table 2)
Many surgical procedures have been proposed over the years to address IOL support in the absence of an intact capsule. e three options surgeons have been anterior chamber IOL, iris fixated IOL, and scleral fixated IOL. e percentages of complications vary among different studies
Summary
Cataract surgery with intraocular lens (IOL) implantation is currently one of the most frequent and successful surgical procedures [1]. Among the most common of these techniques are iris fixation suturing or iris-claw [2,3,4,5,6], anterior chamber IOL implantation [7], scleral fixation IOL with suturing [8], and the most recent: sutureless intrascleral IOL fixation [9,10,11,12], and glued IOL. Sutureless intrascleral fixation was initially introduced by Maggi et al in 1997, followed by the tunnel fixation method, proposed by Gabor Scharioth, and later modified as glued transscleral fixation by Agarwal et al [9]. Is so-called Yamane technique externalizes the haptics of a three-piece IOL using a thin-walled 30- or 27-gauge needle inserted through two transconjunctival sclerotomies. Each haptic of the IOL is carefully placed into the lumen of the needle using
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