Toric Carlevale Secondary Intraocular Lens Implantation In A Paediatric Patient With Traumatic Aphakia

There is no widespread acceptance in the surgical management for aphakic patients in the absence of capsular support. Aphakia may result from traumatic eye injuries, complicated cataract surgery, zonular weakness secondary to pseudoexfoliation or genetic conditions such as Marfan’s syndrome. Numerous techniques have been employed with varying success rates including: anterior chamber intraocular lens (IOL) implantation; iris-fixated sutured IOLs; sutured, scleral fixated IOL and now sutureless scleral fixated IOLs. The authors report on the novel experience of using a toric Carlevale sutureless, scleral-fixated intraocular lens in a 10 year old child with a penetrating eye injury.

This case report took place in the vitreoretinal service in a secondary care eye service of a district general hospital in England, UK.

This is a retrospective, non-comparative, interventional case report of a paediatric patient with traumatic aphakia who underwent implantation with the Carlevale FIL-SSF secondary IOL into the ciliary sulcus. Data were collated using electronic medical records, using Medisoft and scanned written notes. The surgical indication for this case was aphakia secondary to a penetrating eye injury. Pre-operative visual acuity was 1.74 logMAR acuity. Final mean post-operative visual acuity was 0.50 logMAR acuity. The post-operative spherical equivalent of +0.06 dioptres. No post-operative inflammation, cystoid macular oedema, raised intraocular pressures or post-operative lens dislocation was sustained. The Carlevale FIL-SSF IOL offers a novel, sutureless alternative for secondary lens insertion into the ciliary sulcus for aphakic patients without capsular support. The implantation was safe, easy to manipulate with excellent visual outcomes in this patient with no significant complications sustained as a result of this surgical technique. The toric abilities of this lens are also to correct a degree of pre-existing astigmatism.

The Carlevale secondary lens can be a suitable option in paediatric populations without capsular support. We demonstrate the Carlevale FIL-SSF lens as a safe and efficacious secondary implant for managing aphakia in the absence of iris or capsular support. We also highlight its toric capabilities which have not previously been published in the literature (to date) resulting in an excellent functional and visual outcome without significant complications.