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Baur ID, Winkelmann I, Albrecht M, Botros Y, Auffarth GU, Khoramnia R. [Correction of aphakia in cases of insufficient capsular bag stability]. DIE OPHTHALMOLOGIE 2024:10.1007/s00347-024-02097-3. [PMID: 39172164 DOI: 10.1007/s00347-024-02097-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 08/23/2024]
Abstract
A variety of situations can lead to the need for an alternative method of intraocular lens (IOL) fixation if implantation in the capsular bag is not possible. Depending on the situation, sulcus-fixated IOLs, iris-fixated IOLs (IFIOLs) and scleral-fixated IOLs (SFIOLs) are available. With SFIOLs, a distinction is made between suture-fixated and sutureless-fixated techniques. This paper summarizes the advantages and disadvantages of the different approaches, including the newer methods of sutureless SFIOLs. The decision on a specific approach in the individual case depends on both the individual circumstances of the patient and the experience of the surgeon.
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Affiliation(s)
- Isabella D Baur
- Augenklinik des Universitätsklinikums Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
- Augenklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Isabel Winkelmann
- Augenklinik des Universitätsklinikums Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - Michael Albrecht
- Augenklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Youssef Botros
- Augenklinik des Universitätsklinikums Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - Gerd U Auffarth
- Augenklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Ramin Khoramnia
- Augenklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
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Giannopoulos T, Panagiotou ES, Giannoukaki A, Mikropoulos DG, Konstas AG. A New Technique with Scleral Grooves for Sutureless Scleral Fixation of the Carlevale Intraocular Lens. Ophthalmol Ther 2024; 13:2255-2263. [PMID: 38951315 PMCID: PMC11246335 DOI: 10.1007/s40123-024-00986-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/13/2024] [Indexed: 07/03/2024] Open
Abstract
INTRODUCTION A novel technique is described employing scleral grooves to facilitate sutureless scleral fixation of the Carlevale intraocular lens (CIL). We describe its use in a series of 47 patients with aphakia. METHODS A retrospective study of all patients with aphakia who underwent CIL implantation with the new technique by a single surgeon during 1 year. The novelty of this technique consists in the creation of two partial-thickness linear sclerotomies (grooves), 180° apart, 2 mm from and parallel to the limbus. In the middle of each groove a full-thickness sclerotomy is performed to facilitate externalization of the CIL anchors. The groove allows the anchor to plug the full-thickness sclerotomy and to rest within the sclera without protrusion. Reported outcomes include pre-operative/post-operative visual acuity, post-operative spherical equivalent and surgical complications. Follow-up was a minimum of 6 months. RESULTS Forty-eight eyes of 47 patients with aphakia with a mean age of 74 years (range 31-90 years) are included. The commonest causes of aphakia were intraocular lens (IOL) subluxation,with or without exfoliation (54.2%), complicated cataract surgery (29.2%), crystalline lens luxation (6.3%) and trauma (4.1%). All CILs inserted with the new technique stayed successfully in situ during follow-up. Median pre-operative best-corrected visual acuity (0.75 logMAR; range 0.1-2.7) significantly improved to 0.5 logMAR post-operatively (p < 0.001). Moreover, 78% and 65% of the operated cases were within 1.0 and 0.5 diopters, respectively, from intended refraction. The most common complications were transient cystoid macular oedema (8.3%) and transient intraocular pressure rise (8.3%), all of which resolved within 2 months. CONCLUSIONS The proposed modification of sutureless scleral fixation of the CIL appears safe and effective. In our experience it is less time consuming and easier to perform than previous techniques and may therefore offer a useful future option.
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Affiliation(s)
- Theodoros Giannopoulos
- First University Department of Ophthalmology, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kyriakidi 1, 54636, Thessaloniki, Greece
| | - Evangelia S Panagiotou
- First University Department of Ophthalmology, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kyriakidi 1, 54636, Thessaloniki, Greece
| | - Aikaterini Giannoukaki
- First University Department of Ophthalmology, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kyriakidi 1, 54636, Thessaloniki, Greece
| | - Dimitrios G Mikropoulos
- First University Department of Ophthalmology, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kyriakidi 1, 54636, Thessaloniki, Greece
| | - Anastasios G Konstas
- First University Department of Ophthalmology, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kyriakidi 1, 54636, Thessaloniki, Greece.
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Marolo P, Caselgrandi P, Gaidano M, Conte F, Parisi G, Borrelli E, Fallico M, Toro MD, Ventre L, Vaiano AS, Reibaldi M. Long-Term Surgical Outcomes of Scleral Flap versus Scleral Pocket Technique for Sutureless Intrascleral One-Piece Lens Fixation. J Clin Med 2024; 13:4452. [PMID: 39124719 PMCID: PMC11313651 DOI: 10.3390/jcm13154452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/22/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024] Open
Abstract
Objectives: This study compared long-term surgical outcomes of the scleral flap versus scleral pocket technique for sutureless intrascleral one-piece intraocular lens (IOL) fixation. Methods: A retrospective comparative study was conducted at a single center, involving consecutive patients undergoing sutureless intrascleral one-piece IOL implantation, between January 2020 and May 2022. Eyes were divided into two groups based on the surgical technique: group 1 underwent scleral flap (n = 64), and group 2 received scleral pocket technique (n = 59). Visual acuity, refractive outcomes, and complications were assessed over a minimum 24-month follow-up period. Results: Both groups showed improvements in best-corrected visual acuity (BCVA), increasing from 0.84 ± 0.56 logMAR at baseline to 0.39 ± 0.23 logMAR (p = 0.042) at 24 months in group 1 and from 0.91 ± 0.63 logMAR at baseline to 0.45 ± 0.38 logMAR (p = 0.039) at 24 months in group 2. No significant differences in BCVA were observed between the groups at baseline (p = 0.991), 12 (p = 0.496) and 24 months (p = 0.557). Mean spherical equivalent (-0.73 ± 1.32 D in group 1 and -0.92 ± 0.99 D in group 2, p = 0.447), refractive prediction error (-0.21 ± 1.1 D in group 1 and -0.35 ± 1.8 D in group 2, p = 0.377), and surgically induced astigmatism (0.74 ± 0.89 D in group 1 and 0.85 ± 0.76 in group 2, p = 0.651) were comparable between the two groups. An IOL tilt of 5.5 ± 1.8 and 5.8 ± 2.0 degrees (p = 0.867) and an IOL decentration of 0.41 ± 0.21 mm and 0.29 ± 0.11 mm (p = 0.955) were obtained, respectively, in group 1 and group 2 at 24 months. Mean endothelial cell density remained stable at 24 months in both groups (p = 0.832 in group 1 and p = 0.443 in group 2), and it was 1747.20 ± 588.03 cells/mm2 in group 1 and 1883.71 ± 621.29 cells/mm2 in group 2 (p = 0.327) at baseline, 1545.36 ± 442.3 cells/mm2 in group 1 and 1417.44 ± 623.40 cells/mm2 in group 2 (p = 0.483) at 24 months. No cases of endophthalmitis were observed. Conclusions: The scleral pocket technique for sutureless intrascleral one-piece IOL fixation is comparable to the traditional scleral flap technique in terms of long-term visual outcomes and safety. The scleral pocket technique offers a simplified approach and a viable option even for less experienced surgeons.
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Affiliation(s)
- Paola Marolo
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy
| | - Paolo Caselgrandi
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy
| | - Michele Gaidano
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy
| | - Fabio Conte
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy
| | - Guglielmo Parisi
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy
| | - Enrico Borrelli
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy
| | - Matteo Fallico
- Department of Ophthalmology, University of Catania, 95123 Catania, Italy
| | - Mario Damiano Toro
- Department of General Ophthalmology, Medical University of Lublin, 20079 Lublin, Poland
- Eye Clinic, Public Health Department, Federico II University, 80131 Naples, Italy
| | - Luca Ventre
- Department of Ophthalmology, Beauregard Hospital, 11100 Aosta, Italy
| | - Agostino S. Vaiano
- Institute of Ophthalmology, Santa Croce e Carle Hospital, 12100 Cuneo, Italy
| | - Michele Reibaldi
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy
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Barbieri F, Maglionico MN, Casini G, Guidi G, Figus M, Posarelli C. Current Evidence for a New Surgical Technique for Scleral Fixation: The Implantation of a Carlevale Lens, a Systematic Review. J Clin Med 2024; 13:3287. [PMID: 38892997 PMCID: PMC11172714 DOI: 10.3390/jcm13113287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/23/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Background: The Carlevale lens (FIL SSF, Soleko IOL Division, Italy) is a new lens for suture-less scleral fixation. This paper aimed to systematically review articles on this lens, the surgical techniques used for its implantation, complications and outcomes. Methods: This systematic review was performed following the PRISMA guidelines. The search string used was "Carlevale" AND "scleral fixation" from inception until March 2024. For completeness, either case-control studies, case reports or case series written in English were included. The authors used the Newcastle-Ottawa scale for the case-control studies and the JBI Critical Appraisal Checklist for case reports and case series. Results: Twenty-nine articles were included. Scleral fixation with Carlevale lens can be performed by creating scleral flaps or, alternatively, by using scleral pockets. The two sclerotomies must be diametrically opposed, and are preferably created by 25-gauge trocars. A pars plana vitrectomy should be performed every time, and the design of the lens should be suitable for self-anchoring to the sclera; the most accredited strategy to achieve this is to avoid scleral sutures. There were only a few intraoperative and postoperative complications reported; vitreous hemorrhages were the most frequent intraoperative events, while the most relevant postoperative complications were vitreous hemorrhages, cystoid macular oedema and transient variations in the intraocular pressure. Excellent results have been obtained in terms of BCVA, IOL centration and stability, mean intraocular pressure, postoperative spherical equivalent, separation between anterior and posterior chamber and the distance of the IOL from anterior chamber structures. Conclusions: The foldable hydrophilic design of the Carlevale lens has shown good effectiveness, IOL stability and few intra and post-operative complications.
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Affiliation(s)
- Francesca Barbieri
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (F.B.); (M.N.M.); (M.F.)
| | - Maria Novella Maglionico
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (F.B.); (M.N.M.); (M.F.)
| | - Giamberto Casini
- Ophthalmology, Department of Medical and Surgical Specialties, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy; (G.C.); (G.G.)
| | - Gianluca Guidi
- Ophthalmology, Department of Medical and Surgical Specialties, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy; (G.C.); (G.G.)
| | - Michele Figus
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (F.B.); (M.N.M.); (M.F.)
- Ophthalmology, Department of Medical and Surgical Specialties, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy; (G.C.); (G.G.)
| | - Chiara Posarelli
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (F.B.); (M.N.M.); (M.F.)
- Ophthalmology, Department of Medical and Surgical Specialties, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy; (G.C.); (G.G.)
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Sejournet L, Elbany S, Serrar Y, Loria O, Bontemps J, Mathis T, Burillon C, Kodjikian L. FIL SSF intraocular lens opacification after gas tamponade: A case series. Eur J Ophthalmol 2024; 34:NP34-NP38. [PMID: 38233368 DOI: 10.1177/11206721241226743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
PURPOSE To report three cases of postoperative opacification of sutureless scleral-fixed hydrophilic intraocular lens (FIL SSF IOL, Soleko, Italy) after gas tamponade. Two cases occurred after pars plana vitrectomy and one case after Descemet membrane endothelial keratoplasty. CASE REPORT Two diabetic patients underwent a FIL SSF IOL implantation after posterior capsular rupture during cataract surgery. Rhegmatogenous retinal detachment (RRD) was observed in one patient during the initial surgery. A second patient developed a RRD five months after surgery. Both RRDs were treated with pars plana vitrectomy and perfluoroethane (C2F6) gas tamponade. A few days after the surgery, C2F6 was observed in the anterior chamber of both patients. Two months after gas tamponade, opacification of the anterior surface of the IOL was observed. The third patient was a 74-year-old woman, who underwent a combined Descemet membrane endothelial keratoplasty (DMEK) and FIL SSF IOL implantation. Two rebubblings with sulfur hexafluoride (SF6) retreatments were required due to corneal graft detachment. One month later, an opacification of the anterior surface of the IOL was observed. Explantation with implantation of iris-claw IOL was decided, which resulted in an improvement of BVCA. Analysis of the IOL showed a positive Von Kossa staining, indicating calcification of the IOL. We performed a review of all the cases of FIL SSF IOL implantation in our centers. The overall rate of FIL SSF IOL opacification was 2.1% (3/140). Amongst patients treated with gas tamponade, the rate of opacification was 27.3% (3/11). Although FIL SSF IOL implantation appears to be an effective option for the treatment of aphakia, caution should be exercised regarding the risk of opacification following gas tamponade, especially since these patients are at risk of retinal detachment.
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Affiliation(s)
- L Sejournet
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - S Elbany
- Department of Ophthalmology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Y Serrar
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - O Loria
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - J Bontemps
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - T Mathis
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Laboratoire MATEIS, UMR-CNRS 5510, INSA, Université Lyon 1 69100 Villeurbanne, France
| | - C Burillon
- Department of Ophthalmology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - L Kodjikian
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Laboratoire MATEIS, UMR-CNRS 5510, INSA, Université Lyon 1 69100 Villeurbanne, France
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Batsos G, Bouratzis N, Kontomichos L, Casas DR, Atzamoglou S, Peponis V, Karagiannis D, Paroikakis E. A Novel Modified Surgical Approach for FIL SSF Lens. Cureus 2023; 15:e49857. [PMID: 38169895 PMCID: PMC10758903 DOI: 10.7759/cureus.49857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
This study aimed to describe a novel modified surgical technique for FIL SSF lens (Rome, Italy: Soleko) implantation. A retrospective study of FIL SSF lens implantation on six eyes of six patients with subluxated or dislocated intraocular lens (IOL). Standard pars plana vitrectomy (PPV) was performed in all patients. The subluxated or dislocated IOL was removed from a 2.4 corneal incision. From the same incision, the folded FIL SSF lens was inserted. Then lens plugs were extremized through a 23G scleral incision inside two 4 mm pockets that were created at the beginning of the operation. In two cases one pocket had to be converted into a triagonal-shaped scleral flap. All scleral pockets were sutured with 7.0 Vicryl suture and the conjunctiva with 7.0 Vicryl. In the follow-up period of six months, the lens is centered and not tilted. The refractive outcome is within the expectations. Visual acuity is improved in all patients. No haptic exposure and no other complications were noted in all cases. FIL SSF lens is a good option for treating aphakia. This modified implantation technique is safe, fast, and easy. It is also versatile, combining the advantages of both previously described techniques, as it gives the option of flap conversion if needed. Larger studies and prospective comparative studies can highlight the best and more appropriate technique.
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Affiliation(s)
- Georgios Batsos
- First Department of Ophthalmology, Specialized Eye Hospital, Ophthalmiatreio Athinon, Athens, GRC
| | - Nikolaos Bouratzis
- First Department of Ophthalmology, Specialized Eye Hospital, Ophthalmiatreio Athinon, Athens, GRC
| | - Loukas Kontomichos
- First Department of Ophthalmology, Specialized Eye Hospital, Ophthalmiatreio Athinon, Athens, GRC
| | - Diego Ruiz Casas
- Department of Ophthalmology, Ramon y Cajal Hospital, Madrid, ESP
| | - Spyros Atzamoglou
- First Department of Ophthalmology, Specialized Eye Hospital, Ophthalmiatreio Athinon, Athens, GRC
| | - Vasileios Peponis
- First Department of Ophthalmology, Specialized Eye Hospital, Ophthalmiatreio Athinon, Athens, GRC
| | - Dimitris Karagiannis
- Second Department of Ophthalmology, Specialized Eye Hospital, Ophthalmiatreio Athinon, Athens, GRC
| | - Efstratios Paroikakis
- Second Department of Ophthalmology, Specialized Eye Hospital, Ophthalmiatreio Athinon, Athens, GRC
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Boz AAE, Atum M, Özmen S, Yuvacı İ, Çelik E. Comparison of three different intraocular lens implantation techniques in the absence of capsular support: sutured scleral, haptic flanged intrascleral, and four flanged intrascleral fixations. Int Ophthalmol 2023; 43:5045-5053. [PMID: 37851141 DOI: 10.1007/s10792-023-02907-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION After lens extraction, if the capsular bag insufficiency occurs, there are different IOL implantation techniques. IOL implantation in the posterior chamber is safer in eyes with low endothelial cell count, peripheral anterior synechiae, shallow anterior chamber, and glaucoma. Alternative approaches for scleral fixation techniques, both with and without sutures, continue to undergo development. In this study, we aimed to compare the postoperative outcomes of the sutured scleral fixation (SSF), haptic flanged intrascleral fixation (HFISF) and four flanged intrascleral fixation (FFISF) IOL implantation techniques in eyes with the absence of capsular support. MATERIALS AND METHODS A hundred and thirty-seven aphakic eyes with the absence of capsular support were included in the study. The patients were divided into three groups: group 1-SSF, group 2-HFISF (Yamane technique), and group 3-FFISF. Surgical time in minutes, preoperative and postoperative parameters such as best corrected visual acuity (BCVA), corneal astigmatism, lenticular astigmatism, intraocular pressure (IOP), specular microscopy, central macular thickness (CMT) were recorded. Pseudophacodonesis was assessed at 6 months postoperatively using a slit lamp, and early and late complications were recorded. RESULTS Of the 137 eyes, 69 eyes were included in the SSF group, 41 eyes in the HFISF group, and 27 eyes in the FFISF group. No statistically significant differences were observed among the three groups in terms of age, gender, preoperative mean BCVA, corneal astigmatism, IOP, endothelial cell density, and CMT. It was observed that the mean BCVA significantly improved compared to the preoperative visual acuity in all three groups. Postoperative lenticular astigmatism, pseudophacodonesis score, percentage of the endothelial cell loss were found to be higher in FFISF groups. The surgical time was found to be shorter in the HFISF group. IOL decentration was observed in 1.44% of the SSF group and 7.40% of the FFISF group. Cystoid macular edema was observed in 5.79% of the SSF group, 4.87% of the HFISF group, and 7.40% of the FFISF group. Retinal detachment was observed in 1.44% of the SSF group and 7.31% of the HFISF group. CONCLUSIONS The optimal technique for treating aphakia without capsular support remains uncertain. Surgeons are tasked with a complex decision, aiming for both excellent vision and minimal risk. This decision is based on their expertise, the distinctive ocular condition of the patient, and the availability of essential operating room equipment. In this study, the following findings were observed: in the HFISF technique, the average surgical time was found to be shorter, the SSF technique demonstrated greater stability in terms of astigmatism and pseudophacodonesis and the FFISF technique was recognized for its relatively straightforward application method. It is important to note that the three IOL implantation techniques yielded comparable outcomes in terms of postoperative BCVA, as well as early and late complications.
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Affiliation(s)
- Ali Altan Ertan Boz
- Sakarya University Training and Research Hospital, Korukent Sitesi Mimoza 1/12 Korucuk Adapazarı, Sakarya, Turkey.
| | - Mahmut Atum
- Sakarya University Training and Research Hospital, Korukent Sitesi Mimoza 1/12 Korucuk Adapazarı, Sakarya, Turkey
| | - Sedat Özmen
- Sakarya University Training and Research Hospital, Korukent Sitesi Mimoza 1/12 Korucuk Adapazarı, Sakarya, Turkey
| | - İsa Yuvacı
- Sakarya University Training and Research Hospital, Korukent Sitesi Mimoza 1/12 Korucuk Adapazarı, Sakarya, Turkey
| | - Erkan Çelik
- Sakarya University Training and Research Hospital, Korukent Sitesi Mimoza 1/12 Korucuk Adapazarı, Sakarya, Turkey
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Caporossi T, Governatori L, Baldascino A, Mosca L, Scampoli A, D'Amico G, De Vico U, Rizzo S. Modified Carlevale Intraocular Lens Fixation Technique: Two Vitrectomy Ports As Lens Plug Fixation Sites. Retina 2023; 43:2034-2036. [PMID: 34731095 DOI: 10.1097/iae.0000000000003338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe and evaluate the effectiveness of the modified Carlevale intraocular lens (IOL) fixation technique, using two vitrectomy ports as lens plug fixation sites. MATERIALS AND METHODS This prospective, consecutive, interventional study examined 60 eyes in 60 patients, who underwent 25- or 23-gauge vitrectomy for an IOL subluxation/luxation, lens dislocation, or aphakia, with Carlevale IOL implantation. RESULTS Postoperatively, transient ocular hypotension was observed in four eyes. The mean refractive prediction error was -0.27 ± 0.78 diopters. No postoperative complications, such as retinal detachment, endophthalmitis, or IOL dislocation, were observed in the 4-month follow-up. CONCLUSION This new technique may be simple, fast, and effective because of fewer scleral wounds and fewer postoperative complications.
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Affiliation(s)
- Tomaso Caporossi
- Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy; and
| | - Lorenzo Governatori
- Department of NEUROFARBA, Ophthalmology, University of Florence, Careggi, Florence, Italy
| | - Antonio Baldascino
- Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy; and
| | - Luigi Mosca
- Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy; and
| | - Alessandra Scampoli
- Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy; and
| | - Guglielmo D'Amico
- Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy; and
| | - Umberto De Vico
- Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy; and
| | - Stanislao Rizzo
- Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy; and
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Ripa M, Angunawela R, Motta L. SCLERAL FIXATION OF CARLEVALE INTRAOCULAR LENS: A Systematic Review and Meta-Analysis. Retina 2023; 43:1750-1762. [PMID: 37399540 DOI: 10.1097/iae.0000000000003873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
PURPOSE The mean change in best-corrected visual acuity (BCVA), intraocular pressure, and endothelial cell counts after intraocular lens (IOL) implantation and the incidence rate of postoperative complications were estimated by systematic review and meta-analysis to assess the surgical and refractive outcomes of the sutureless scleral fixation Carlevale IOL. METHODS A literature search was conducted using PubMed, Embase, and Scopus. The weighted mean difference (WMD) was used to present the mean change in BCVA, intraocular pressure, and endothelial cell count after IOL implantation, whereas a proportional meta-analysis was used to estimate the pooled incidence rate of postoperative complications. RESULTS In the meta-analysis of 13 studies involving 550 eyes, the pooled WMD of the mean change in BCVA showed a significant improvement in BCVA in patients who underwent Carlevale IOL implantation (WMD = 0.38, 95% confidence interval: 0.30-0.46, P < 0.001; heterogeneity [I 2 ] = 52.02%). The subgroup analyses indicated that the mean change in BCVA was not significantly higher according to the last follow-up visit, with no statistically significant subgroup effect ( P = 0.21) (WMD up to 6 months: 0.34, 95% confidence interval: 0.23-0.45, I 2 = 58.32%, WMD up to 24 months: 0.42, 95% confidence interval: 0.34-0.51, I 2 = 38.08%). In the meta-analysis of 16 studies involving 608 eyes, the pooled incidence rate of postoperative complications was equal to 0.22 (95% confidence interval: 0.13-0.32, I 2 = 84.87, P ≤ 0.001). CONCLUSION Carlevale IOL implantation represents a reliable method of restoring vision in eyes with missing capsular or zonular support.
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Affiliation(s)
- Matteo Ripa
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, United Kingdom; and
| | | | - Lorenzo Motta
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, United Kingdom; and
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Iannetta D, Febbraro S, Valsecchi N, Moramarco A, Fontana L. FIL SSF intraocular lens opacification after pars plana vitrectomy with gas tamponade for traumatic lens luxation and retinal detachment: a case report and literature review. BMC Ophthalmol 2023; 23:383. [PMID: 37743488 PMCID: PMC10519003 DOI: 10.1186/s12886-023-03126-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND To report a case of sutureless scleral-fixated hydrophilic intraocular lens (FIL SSF IOL, Soleko, Italy) opacification following pars plana vitrectomy surgery using sulfur hexafluoride (SF6) for traumatic lens luxation associated with retinal detachment. CASE PRESENTATION A 77-year-old woman was referred to our emergency department after blunt trauma in her right eye. At the ophthalmic evaluation, visual acuity was hand movement, biomicroscopy showed pseudoexfoliation syndrome and a traumatic lens luxation in the vitreous chamber. The patient underwent pars plana vitrectomy, subluxated cataract explantation, and FIL SSF IOL implant. During surgery, an inferior retinal detachment was encountered, requiring 20% SF6 gas tamponade. No adverse events were encountered. One month postoperatively, visual acuity (BCVA) improved to 0,3 logMAR. At the 3-month follow-up, the patient presented with BCVA of 0,5 logMAR, and biomicroscopy showed a minimal IOL opacification. Six months postoperatively, BCVA decreased to 1.0 logMAR, and diffuse, IOL opacification was noted at slit lamp examination. The patient refused any other surgical intervention for IOL exchange. CONCLUSIONS Although hydrophilic IOL opacification gas related is known, to the best of our knowledge, this is the first case reported in the literature of FIL SSF IOL opacification after pars plana vitrectomy with gas tamponade for retinal detachment.
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Affiliation(s)
- Danilo Iannetta
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy.
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9 Bologna, Postal code, 40138, Bologna, Italy.
| | - S Febbraro
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9 Bologna, Postal code, 40138, Bologna, Italy
| | - N Valsecchi
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9 Bologna, Postal code, 40138, Bologna, Italy
| | - A Moramarco
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9 Bologna, Postal code, 40138, Bologna, Italy
| | - L Fontana
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9 Bologna, Postal code, 40138, Bologna, Italy
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11
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Shao Y, Luan R, Liu JP, Hu BJ, Li XR. Supporting suture combined scleral fixation of toric IOL implantation in traumatic aniridia, aphakia and corneal astigmatic eye: a case report. Int J Ophthalmol 2023; 16:1559-1560. [PMID: 37724271 PMCID: PMC10475631 DOI: 10.18240/ijo.2023.09.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/17/2023] [Indexed: 09/20/2023] Open
Affiliation(s)
- Yan Shao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 384300, China
| | - Rong Luan
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 384300, China
| | - Ju-Ping Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 384300, China
| | - Bo-Jie Hu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 384300, China
| | - Xiao-Rong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 384300, China
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12
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Coco G, Ferrara M, Borgia A, Romano D, Romano V. Carlevale intraocular lens opacification after Descemet stripping automated endothelial keratoplasty. Eur J Ophthalmol 2023; 33:NP60-NP62. [PMID: 36163691 DOI: 10.1177/11206721221128669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report a case of sutureless scleral-fixated (SSF) Carlevale intraocular lens (IOL) opacification following Descemet stripping automated endothelial keratoplasty (DSAEK) surgery. METHODS An 82-year-old man underwent combined SSF Carlevale IOL implant and DSAEK surgery for aphakic endothelial decompensation. Surgery was uneventful, while the postoperative period was complicated by multiple graft detachments requiring re-bubbling. After four re-bubbling procedures, the corneal graft attached and cleared over time. RESULTS 29 months after combined SSF IOL implant and DSAEK surgery, the patient presented with decreased vision due to IOL opacification affecting the visual axis. CONCLUSION Although combined SSF IOL and DSAEK surgery is an overall safe and effective procedure for aphakic endothelial decompensation, risk of IOL opacification due to anterior chamber air injection is higher when using hydrophilic IOLs and in cases requiring multiple re-bubbling, therefore, intraocular lens material should be chosen after considering the risks and benefits.
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Affiliation(s)
- Giulia Coco
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Mariantonia Ferrara
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - Alfredo Borgia
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Davide Romano
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, Viale Europa 15, 25123 Brescia, Italy
| | - Vito Romano
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, Viale Europa 15, 25123 Brescia, Italy
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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13
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Khoramnia R, Baur ID, Auffarth GU. Aetiology and Management of IOL Dislocations. Klin Monbl Augenheilkd 2023; 240:971-980. [PMID: 37494272 DOI: 10.1055/a-2074-9028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Early (< 3 months) intraocular lens (IOL) dislocation occurs due to insufficient fixation in the capsular bag, while late dislocation (≥ 3 months) is due to increasing insufficiency of the zonular apparatus. Iris-fixated IOL (IFIOL) and suture- or sutureless-fixated scleral IOL (SFIOL) are currently the most commonly used methods when IOL exchange is indicated. Different methods of scleral fixation with or without sutures have been described. The most important techniques are summarised in this paper. IFIOL and SFIOL allow comparable visual outcomes but differ in their risk profile. The decision of which method to use should be made case by case and in accordance with the surgeon's preference.
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Affiliation(s)
- Ramin Khoramnia
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, Deutschland
| | - Isabella Diana Baur
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, Deutschland
| | - Gerd U Auffarth
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, Deutschland
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14
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Schranz M, Reumüller A, Kostolna K, Novotny C, Schartmüller D, Abela-Formanek C. Refractive outcome and lens power calculation after intrascleral intraocular lens fixation: a comparison of three-piece and one-piece intrascleral fixation technique. EYE AND VISION (LONDON, ENGLAND) 2023; 10:29. [PMID: 37291668 DOI: 10.1186/s40662-023-00341-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/30/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE To evaluate the refractive prediction error of common intraocular lens (IOL) power calculation formulae in patients who underwent intrascleral IOL fixation using two different techniques. METHODS This is a prospective, randomized, longitudinal, single-site, single-surgeon study. Patients who underwent intrascleral IOL implantation using the Yamane or the Carlevale technique were followed up for a period of six months postoperatively. Refraction was measured using the best-corrected visual acuity at 4 m (EDTRS chart). Lens decentration, tilt and effective lens position (ELP) were assessed using an anterior segment optical coherence tomography (AS-OCT). The prediction error (PE) and the absolute error (AE) were evaluated for the SRK/T, Hollayday1 and Hoffer Q formula. Subsequently, correlations between the PE and axial length, keratometry, white to white and ELP were assessed. RESULTS In total, 53 eyes of 53 patients were included in the study. Twenty-four eyes of 24 patients were in the Yamane group (YG) and 29 eyes of 29 patients were in the Carlevale group (CG). In the YG, the Holladay 1 and Hoffer Q formulae resulted in a hyperopic PE (0.02 ± 0.56 D, and 0.13 ± 0.64 D, respectively) while in the SRK/T formula the PE was slightly myopic (- 0.16 ± 0.56 D). In the CG, SRK/T and Holladay 1 formulae led to a myopic PE (- 0.1 ± 0.80 D and - 0.04 ± 0.74 D, respectively), Hoffer Q to a hyperopic PE (0.04 ± 0.75 D). There was no difference between the PE of the same formulae across both groups (P > 0.05). In both groups the AE differed significantly from zero in each evaluated formula. The AE error was within ± 0.50 D in 45%-71% and was within ± 1.00 D in 72%-92% of eyes depending on the formula and surgical method used. No significant differences were found between formulae within and across groups (P > 0.05). Intraocular lens tilt was lower in the CG (6.45 ± 2.03°) compared to the YG (7.67 ± 3.70°) (P < 0.001). Lens decentration was higher in the YG (0.57 ± 0.37 mm) than in the CG (0.38 ± 0.21 mm), though the difference was not statistically significant (P = 0.9996). CONCLUSIONS Refractive predictability was similar in both groups. IOL tilt was better in the CG, however this did not influence the refractive predictability. Though not significant, Holladay 1 formula seemed to be more probable than the SRK/T and Hoffer Q formulae. However, significant outliers were observed in all three different formulae and therefore remain a challenging task in secondary fixated IOLs.
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Affiliation(s)
- Markus Schranz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Adrian Reumüller
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Klaudia Kostolna
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Caroline Novotny
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Daniel Schartmüller
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Claudette Abela-Formanek
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Franco F, Serino F, Vicini G, Nicolosi C, Giansanti F. Comparison of Visual and Aberrometric Outcomes in Suture-Free Scleral Fixation: Three-Piece Lenses versus Carlevale Lenses. J Clin Med 2022; 12:jcm12010188. [PMID: 36614989 PMCID: PMC9821684 DOI: 10.3390/jcm12010188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Purpose: To compare the refractive results between sutureless scleral fixation intraocular lens (IOLs) (Carlevale, Soleko) and suture-free scleral fixation three-piece IOLs (Sensar AR40, Johnson & Johnson) for secondary implantation in patients with IOL dislocation or aphakia. Methods: This is a monocentric retrospective study on 28 patients (28 eyes) with sutureless scleral fixation Carlevale IOL and 25 patients (25 eyes) with suture-free scleral fixation three-piece IOL. Best-corrected visual acuity (BCVA) evaluation, refractive measures and IOL tilt evaluation with anterior segment optical coherence tomography were conducted at one, three, six and twelve months after surgery. Point Spread Function (PSF) was measured using a total ocular aberrometer. Results: BCVA in both groups improved since the postoperative visit at 1 month and reached a stable value at 3 months At month 12, mean BCVA was 0.23 logMAR in group one and 0.32 logMAR in group two. Mean IOL tilt angle at 12 months was 2.76° ± 1.87 in group one and 2.51° ± 1.80 in group two. PSF at 12 months was 0.18 ± 0.09 in group one and 0.15 ± 0.05 in group two. There were no statistically significant differences (p > 0.05) for all comparisons. The post-operative complications were similar within the two groups. Conclusions: Our results show that secondary IOL implantation has similar visual and surgical outcomes when a sutureless Carlevale lens scleral fixation and a suture-free scleral fixation three-piece IOL are used.
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Affiliation(s)
- Fabrizio Franco
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50139 Florence, Italy
| | - Federica Serino
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50139 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50139 Florence, Italy
- Correspondence:
| | - Giulio Vicini
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50139 Florence, Italy
- Azienda USL Toscana Nord Ovest, 56121 Pisa, Italy
| | - Cristina Nicolosi
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50139 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50139 Florence, Italy
| | - Fabrizio Giansanti
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50139 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50139 Florence, Italy
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16
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Carlà MM, Boselli F, Giannuzzi F, Caporossi T, Gambini G, Mosca L, Savastano A, Rizzo S. Sutureless scleral fixation Carlevale IOL: a review on the novel designed lens. Int Ophthalmol 2022; 43:2129-2138. [DOI: 10.1007/s10792-022-02579-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/12/2022] [Indexed: 11/27/2022]
Abstract
AbstractBackground: Complicated cataract surgery is the main cause of secondary lens implantation surgery. Several approaches have been introduced to face those circumstances. As it concerns scleral-fixated IOLs for the posterior chamber, many types of IOL can be implanted. The aim of article is to review the single piece sutureless scleral fixation Carlevale lens; Methods: Narrative review; Results: Several works described as safe the IOL implantation utilizing the handshake approach, without tactile manipulation, which allows for self-centration and lens firm fixation in uncomplicated surgery. This allows to reduce high order aberration such as astigmatism and coma, with a very good postoperative BCVA Conclusions: Carlevale lens is one of the best option to manage insufficient capsular support.
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Scleral Fixation of Akreos AO60 Intraocular Lens Using Gore-Tex Suture: An Eye on Visual Outcomes and Postoperative Complications. J Ophthalmol 2021; 2021:9349323. [PMID: 34966559 PMCID: PMC8712131 DOI: 10.1155/2021/9349323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/04/2021] [Accepted: 11/15/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose “In-the-bag” placement of an IOL is the Holy Grail for any cataract surgeon. However, in the absence of capsular integrity, alternative surgical options to place the IOL must be sought. We aim to report the clinical outcomes and safety profile of scleral-fixated Akreos AO60 intraocular lens implantation using Gore-Tex suture, combined with pars plana vitrectomy. Methods This is a single-center, retrospective case series descriptive study. Electronic clinical records of all patients subjected to scleral fixation of a Bausch and Lomb Akreos AO60 IOL combined with pars plana vitrectomy, between April 1, 2017, and August 1, 2021, were reviewed. Data concerning age, sex, laterality, past ophthalmological history, pre- and postoperative best-available visual acuity, surgical indication, and intra- and postoperative complications were collected. Measured outcomes were the differences in best-available visual acuity and frequency of postoperative complications. Results A total of 37 eyes (20 right eyes and 17 left eyes) from 36 patients (16 females and 20 males) were included in the statistical analysis. The mean age at time of surgery was 72.0 ± 12.4 years. The mean follow-up period was 548.9 days (range 39–1564 days). Globally, the mean best-available logMAR visual acuity improved from 1.61 preoperatively (0.025 decimal equivalent) to 0.57 postoperatively (0.3 decimal equivalent), this difference being statistically significant (P < 0.001). Indications for surgery included aphakia due to complicated cataract surgery (24.3%; n = 9); subluxated IOL due to closed trauma (21.6%; n = 8); PEX-related subluxated IOL (16.2%; n = 6); non-traumatic, non-PEX-related subluxated IOL (18.9%; n = 7); subluxated crystalline lens due to closed trauma (8.1%; n = 3); aphakia due to open-globe injury (5.4%; n = 2); silicone-induced IOL opacification (2.7%; n = 1); and aphakia post-endophthalmitis (2.7%; n = 1). Postoperative complications included transient ocular hypertension (27.0%; n = 10), transient corneal edema (18.9%; n = 7), cystoid macular edema (18.9%, n = 7), self-limited hypotension (5.4%, n = 2), self-limited vitreous hemorrhage (2.7%, n = 1), central retinal vein occlusion (2.7%, n = 1), late retinal detachment (2.7%, n = 1), and Akreos IOL opacification (2.7%, n = 1). No suture-related complications were observed. Conclusion There was a statistically significant improvement in visual acuity after scleral fixation of Akreos AO60 intraocular lens using Gore-Tex suture, with no suture-related problems recorded. This procedure seems to be a valuable alternative for posterior chamber IOL placement when secondary IOL implantation is required.
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