ESCRS - PP22.10 - When The Bag Is Not An Option: A Scleral-Based Solution

When The Bag Is Not An Option: A Scleral-Based Solution

Published 2022 - 40th Congress of the ESCRS

Reference: PP22.10 | Type: Free paper | DOI: 10.82333/8th9-qt53

Authors: Diogo Bernardo Matos* 1 , Mun Yueh Faria 2 , Pedro Gomes 2 , Helena Proença 2 , Afonso Cabrita 2 , Carlos Marques-Neves 3 , Nuno Pinto Ferreira 2

1Ophthalmology,Centro Hospitalar Universitário Lisboa Norte,Lisboa,Portugal;Faculty of Medicine,University of Lisbon,Lisboa,Portugal, 2Ophthalmology,CHLN - Hospital Santa Maria,Lisboa,Portugal, 3Faculty of Medicine,University of Lisbon,Lisboa,Portugal

Purpose

Description of several surgical technique modifications developed for implanting a Sutureless Scleral Fixated (SSF) retropupillary intra-ocular lens (IOL). This work aims to describe the learning curve and surgical evolution within Centro Hospitalar Universitário Lisboa Norte, alongside with the description of the most frequent surgical complications registered for Carlevale® IOL implantation, an "on-label" IOL option for aphakia.

Setting

This study was conducted at Hospital Santa Maria - Centro Hospitalar e Universitário Lisboa Norte (HSM-CHULN), a government funded teaching hospital and tertiary care nationwide referral centre. SSF has been used at HSM-CHULN since 2020. All data was collected from patient’s Electronic Medical Record under explicit informed consent.

Methods

Retrospective observational study. All patients undergoing SSF implantation between January 2020 and July 2021 with 6-month follow-up were included. The primary outcome was defined as the variation in best corrected visual acuity between the pre-operative follow-up and the 6-month follow-up. Secondary outcomes reported included pre- and post-operative refraction and any complication reported during follow-up. A preoperative evaluation was performed in all patients, and the refractive status compared to the post-operative evaluation. Surgical complications were recorded, and their resolution was further discussed. Post-operative Effective Lens Position (ELP) and IOL tilt were evaluated through Ultrasound BioMicroscope (UBM) protocols.

Results

Twenty eyes of 20 patients with aphakia, dislocated IOL or subluxated lens who underwent SSF IOL implantation were studied. 10 eyes with IOL/bag luxations, 2 eyes with sub-luxated crystalline and 8 eyes with aphakia (6 eyes post-cataract surgery; 2 eyes post ocular trauma).

Mean pre-operative Best Corrected Visual Acuity (BCVA) was 1.28 ± 0.38 logarithm of the minimum angle of resolution (logMAR) and improved to 0.65 ± 0.57 logMAR at the 6-month follow-up.

Four patients presented post-operative ocular hypertension, one patient experienced a transient cystoid macular edema and one patient experienced a vitreous haemorrhage. No conjunctival erosion, plug externalization or IOL dislocation were reported during follow-up.

Conclusions

The SSF IOL seems to be a solution for eyes where the capsular bag is not capable of supporting an IOL. This new IOL design allows for a scleral-based solution that avoids the most common complication of other techniques such as iris-supported IOLs. Although this IOL design seems overall safe and presents promising post-operative refractive outcomes, the learning-curve for its placement is steep and demands a close follow-up monitoring.

Further studies with large cohort of multicentric data should be performed to compare SSF IOL to iris-claw devices and other scleral supported techniques either with scleral-sutured IOLs or Yamane techniques.