Evaluations of bridging sutures in preventing iris capture in eyes with intrascleral fixation of implanted intraocular lens

Reverse Pupillary Block after Implantation of a Sutureless Scleral Fixation Carlevale Intraocular Lens

PURPOSE

To describe the incidence, complications and management of reverse pupillary block (RPB) after implantation of Carlevale intraocular lens (IOL).

DESIGN

Multicenter, retrospective, cross-sectional study.

PARTICIPANTS

Of a sample of 128 patients that had undergone Carlevale IOL implantation, 19 patients were found to present RPB.

METHODS

Nineteen patients with RPB after Carlevale IOL implantation were evaluated and treated with laser peripheral iridotomy (LPI).

MAIN OUTCOME MEASURES

Demographic data (age and gender), data on preexisting medication, axial length (Zeiss IOLMaster 500 and Zeiss IOLMaster 700), presence of pseudoexfoliation material, presence of RPB (anterior segment swept-source SS-OCT Anterion, Heidelberg Engineering), presence of macular edema (Irvine Gass syndrome, OCT Spectralis, Heidelberg Engineering), anterior chamber depth (ACD) before and after LPI, best-corrected visual acuity (BCVA) before and after LPI, and intraocular pressure (IOP) before and after LPI were analyzed.

RESULTS

An incidence of RPB of 14.8% was found. The prevalence of pseudoexfoliation syndrome was 21.1%, and 42.1% of patients presented an axial length >24.00 mm. Mean pre-LPI ACD was 4.78 ± 0.465 mm and post-LPI ACD was 4.23 ± 0.404 mm, a statistically significant increase of 0.54 mm (P < 0.001; 95% confidence interval, 0.26-0.83) of ACD was observed. There were no differences between pre- and post-LPI BCVA. Pre-LPI IOP was 17.10 (range, 12-34) mmHg and post-LPI IOP was 14.47 (range, 10-21) mmHg, (P = 0.391). Cystic macular edema (Irvine Gass) was identified in 4 of 19 patients, reporting an incidence of 21.1% in RPB cases.

CONCLUSIONS

Reverse pupillary block is a relatively common complication after Carlevale lens implantation, which may be associated with an increase of macular edema incidence but does not clearly correlate an increase of IOP. Our hypothesis is that indentation of the sclera induces a posterior rotation of the peripheral iris, causing RPB. Our results encourage looking over the Carlevale IOL implantation technique to consider a routinely intraoperative surgical peripheral iridotomy to avoid RPB and its further complications.

FINANCIAL DISCLOSURE(S)

The authors have no proprietary or commercial interest in any materials discussed in this article.

Impact of lens capsule status on pupillary capture following intrascleral intraocular lens fixation: a retrospective study

BACKGROUND

Pupillary capture can cause complications after intrascleral intraocular lens (IOL) fixation; however, no method has been established to definitively prevent pupillary capture. Therefore, we aimed to examine the differences in the incidence of pupillary capture in patients who underwent intrascleral IOL fixation and had intraoperative lens capsule preservation or lens capsule loss.

METHODS

This single-center, retrospective study, conducted at a University Hospital, included 83 eyes from 83 patients. The eyes were allocated to the capsule and no-capsule groups based on the presence or absence of capsule, respectively. Patient demographics, causative diseases, incidence of pupillary capture at 1 year postoperatively, anterior chamber depths (ACDs), IOL tilts, and decentrations of the two groups were analyzed and compared.

RESULTS

The capsule and no-capsule groups comprised 26 and 57 eyes, respectively. The indications for intrascleral IOL fixation were: IOL dislocation in 6 (23.1%) and 41 (71.9%), artificial aphakia in 4 (15.4%) and 2 (3.5%), conversion during cataract surgery due to complications (zonular dialysis or posterior capsule rupture) in 14 (53.9%) and 3 (5.3%), lens dislocation in 0 and 11 (19.3%), and IOL opacification in 2 (7.7%) and 0 eyes in the capsule and no-capsule groups, respectively (P < 0.05). The postoperative outcomes including ACD, magnitude of tilt, or decentration of the fixed IOL did not differ between the two groups (P > 0.05). Pupillary capture was observed in eight eyes, all in the no-capsule group (P < 0.05).

CONCLUSIONS

When performing intrascleral fixation in cases where the lens capsule remains, preserving the capsule and fixing the IOL under the capsule may prevent postoperative pupillary capture.

Case report: Management of recurrent pupillary optic capture with sutureless surgical technique using 7-0 polypropylene flange

Background

To report a novel surgical technique for recurrent pupillary optic capture after flanged intraocular lens (IOL) fixation.

Methods

In this retrospective case series, we detail our use of two parallel 7-0 polypropylene sutures passed between the iris plane and the optic of scleral-fixated IOL to address pupillary optic capture. Flanges were created using ophthalmic cautery to secure it to the sclera without suture.

Results

Two eyes with pupillary optic capture underwent a sutureless surgical technique using 7-0 polypropylene flanges. No recurrences of pupillary optic capture were observed during the 1-year follow-up.

Conclusion

Our sutureless surgical technique using a 7-0 polypropylene flange was an effective, efficient, and less invasive approach for treating recurrent pupillary optic capture.