Implantation Of A Scleral Fixated Intraocular Lens In The Absence Of The Capsular Bag: A One Year Follow-Up

To evaluate the long-term (1year) outcome in patients who have undergone scleral intraocular lens fixation. 

Department for Ophthalmology and Optometry, Medical University of Vienna, Austria

This prospective single surgeon follow-up study involved Patients who have undergone transscleral IOL implantation using the Carlevale technique due to IOL dislocation, complicated cataract surgery or trauma resulting in aphakia.

Patients were evaluated for their postoperative visual acuity (VA), refractive outcome, surgical induced astigmatism (SIA), IOL decentration & tilt, scleral pocket thickness (SPT) above the haptics and adverse events such as macular edema, ocular tension, retinal detachment, dry eye disease and iris retropulsion(IR).

To determine refractive outcome, the refractive prediction error(PE) was calculated, for measuring tilt, decentration, SIA & SFT the Casia2 anterior segment optical coherence tomography(AS-OCT) was used.

A total of 30 eyes of 30 patients were evaluated. Mean patient age was 71±12a.

Most of the patients showed spontaneous in the bag luxation (20/30), followed by aphakia (5/30), IOL opacification (3/30) and phakic luxation (2/30)

Mean preoperative VA was 20/40, which increased to 20/32 snellen postoperativly, respectively (p=0.007).

Almost 80% of all eyes were within a PE range of ±1D.

Mean IOL tilt and decentration stayed stable over FUP-period (tilt: w1: 5.7±2.01° m12: 6.5±2.0°, p=0.16; decentration: w1: 0.35±0.23mm, m12: 0.35±0.22mm, p=0.94). Mean SPT at m3 was 288±111µm at 0° and 323±121µm at 180° (p=0.79), at month 12 it decreased to 270±137µm at 0°(p=0.906) and 272±187µm at 180°(p=0.1706), respectively.

The Carlevale method for scleral IOL fixation is a very user-friendly and reproducible procedure in patients with missing capsular support, which results in good visual acuity and predictable refractive outcomes.

The haptic design of the IOL results in very good centration and tilt over a longer follow up period.

The use of scleral pockets proved to be a safe method for haptic placement and covering which showed no thinning over the FUP period of 1 year and subsequently no conjunctival erosion and haptic exposure.

However, patients must be followed up closely to detect adverse events such as macular edema and Sicca syndrome.