One Year Outcomes and Stability of a Novel Scleral Anchored Intraocular Lens

Refining delivery and positioning: A modified approach to FIL SSF intraocular lens implantation using the "full reverse" technique

PURPOSE

To present a modified surgical technique for implantation of the sutureless scleral-fixated hydrophilic intraocular lens (FIL SSF).

METHODS

Single surgeon retrospective case series and review of surgical videos with step-by-step technique analysis. Uncorrected and best corrected visual acuity (UCVA and BCVA), refractive error (spherical equivalent), full clinical examination with intraocular pressure (IOP) measurement, endothelial cell density on corneal specular microscopy and macular optical coherence tomography (OCT) were recorded at baseline, 1, 4 and 8 weeks postoperatively.

RESULTS

The FIL SSF IOLs were successfully implanted using the so-called "full reverse" technique, having the lens loaded in the injector in an upside-down fashion, as opposed to IOL technical specifications. In all cases, the FIL SSF IOL was properly placed in the ciliary sulcus, well-centered and without signs of tilt. Follow up figures at 2 months are consistent with published data, confirming the potential benefits of the new implantation technique.

CONCLUSION

In our preliminary experience, the "full reverse" technique of the FIL SSF IOL has proven effective in preventing incorrect IOL orientation in 100% of cases. However, larger prospective controlled studies and longer follow up are required to either support or disprove our results.

Intraoperative OCT evaluation of the stability and centering of carlevale IOL with different intrascleral fixation techniques

BACKGROUND

To evaluate intrascleral plug stability and correct centring of the IOL in three different surgical techniques using intraoperative anterior segment OCT.

METHODS

This retrospective scientific study was conducted by reviewing patient records from the Ophthalmology Unit at the Civico Hospital of Palermo, covering the period between 2021 and 2022. Three distinct groups of patients, each consisting of 7 eyes from 7 individual patients, were included in this study. The first group received a quadrangular scleral flap (3.5 × 3.5 mm) that covered intrascleral plugs. The second group had two intrascleral pockets created with the insertion of plugs inside these pockets. The third group had one intrascleral pocket created to cover the intrascleral plugs. Intraoperative anterior segment (AS)-OCT was used to monitor the positioning of the plugs and the tilt of the IOL. The analyzed parameters are: best-corrected visual acuity (BCVA), subjective refraction, intraocular pressure (IOP), pachymetry, macular thickness, endothelial cell loss, intraoperative and postoperative complications, IOL tilting, and optic plate decentration.

RESULTS

The examined parameters showed uniformity among the groups. Postoperative best-corrected visual acuity (BCVA), subjective refraction, intraocular pressure (IOP), pachymetry, and macular thickness exhibited no significant differences between the three groups. Endothelial cell loss ranged between 10.4% and 13.1% across the patient groups. No intraoperative or postoperative complications were reported. No IOL tilting or optic plate decentration was reported. The duration of surgeries was similar among the groups.

CONCLUSIONS

The three different scleral fixation techniques have been shown to be equally effective, demonstrating the usefulness of intraoperative AS-OCT for the stability and centring of Carlevale IOLs.

Different Methods of Secondary Intraocular Lens Implantation

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Flapless and Conjunctiva-Sparing Technique for Transscleral Fixation of Intraocular Lens to Correct Refractive Errors in Eyes without Adequate Capsular Support

Purpose

To evaluate refractive outcomes, intraocular lens (IOL) power calculation, and IOL position following a novel conjunctiva-sparing transscleral fixation technique.

Methods

Forty-one eyes of 40 patients managed with a flapless transscleral-sutured technique were included. Preoperative and postoperative refractive errors (spherical equivalents, SE) were compared. IOL position was assessed on the Scheimpflug images. IOL power was calculated by SRK/T, Holladay 1, and Hoffer Q formulas.

Results

The mean age was 57.39 ± 14.83 years (range: 26 to 79 years), and the mean follow-up was 7.46 ± 6.42 months (range: 1 to 24 months). Surgical indications were aphakia (n = 14), subluxated lenses (n = 3), and IOL dislocation (n = 24). The SE was 4.50 ± 6.38 diopter (D) (range: -3.75 to 13.75 D) preoperatively and -1.68 ± 1.57 D (range: -5.50 to 1.13 D) postoperatively (P < 0.001). The mean tilt angle and decentration were 2.90° ± 1.93° (range: 0.39° to 9.10°) and 0.23 ± 0.19 mm (range: 0.02 to 0.94 mm) vertically, and 1.75° ± 1.41° (range: 0.24° to 7.65°) and 0.18 ± 0.19 mm (range: 0.02 to 1.06 mm) horizontally, which were clinically insignificant. All three IOL formulas produced myopic errors (range: -0.29 to -0.50 D). The SRK/T had the lowest median absolute error (0.55 D), followed by the Holladay 1 (0.70 D) and the Hoffer Q (0.74 D). The three formulas had the same percentage of prediction errors (PEs) within ±0.5 D (43.48%), while the Hoffer Q had the highest percentage of PEs within ±1.0 D (82.61%).

Conclusion

The present technique can serve as an alternative approach for transscleral IOL fixation and refractive correction in eyes with compromised capsular support, ensuring the stability of IOLs and reasonable IOL power calculation accuracy.