The "Full Reverse" Technique For Sutureless Scleral Fixation Of The Fil Ssf Iol

Scleral fixation (SF) of an intraocular lens (IOL) is a valuable option to treat aphakic patients without adequate capsular support. Recently, sutureless SF has gained popularity and in 2016, the FIL SSF IOL (Soleko S.p.a., Italy), was introduced. A recent survey, among Italian surgeons, reported that one major difficulty while implanting the IOL is the unpredictable unfolding of the leading haptic that may result in upside-down IOL implantation (unpublished data). In such cases, further manipulation to twist the IOL is required. We have tested the so called “full reverse” technique, for the first time in vivo, with the aim of reducing unpredictable IOL twist during implantation.

Public healthcare hospital, ophthalmology department.

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 week, 1 and 2 months.

The “full reverse” technique

The IOL was loaded in the cartridge in an upside-down fashion, with the reference notches oriented inferiorly on the right side and superiorly on the left side (Fig. 1). The tip of the cartridge was inserted into the anterior chamber (bevel down position) (Fig. 2), then rotated in a bevel up position (Fig. 3) and the lens was injected. Once the leading haptic unfolded, it was picked with the forceps and externalized. Correct IOL orientation was confirmed (Fig. 4). The second haptic was then externalized through the right side sclerotomy. Pre/postoperative data of our cohort is summarized in Table 1. Only one patient developed self resolving hyphema and three patients had transient IOP rise treated medically.

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. Added to this, follow up figures at 2 months are consistent with published data, confirming the potential benefits of the new implantation technique. However, larger prospective studies, with strict inclusion and exclusion criteria, are required to either confirm or confute our findings.