Four-Flanged Scleral Fixation Of A Four-Eyelet Foldable Hydrophobic Intraocular Lens With A Modified Canabrava Technique To Correct Aphakia In The Absence Of Capsular Support

To evaluate the visual results and complications of a secondary implantation technique in which a 4-eyelet foldable hydrophobic intraocular lens (IOL) is fixated to the sclera in four points by four flanges. Fixation was performed using the Canabrava technique with the following modifications: a hydrophobic IOL was used instead of a hydrophilic IOL, to reduce the risk of IOL opacification; 30g ultra-thin wall needle and 6/0 prolene were employed instead of 26g needle and 5/0 prolene, to reduce the size of the flange; 2.2mm incision in cases of IOL implantation to correct aphakia only was used instead of 3.4mm incision. 3.2mm incision was employed if an IOL exchange procedure was required, instead of 3.4mm in the original Canabrava technique

Department of Ophthalmology, Complexo Hospitalario Universitario A Coruña, tertiary referral center.

Retrospective, non-comparative case series. Consecutive cases of secondary implantation of a 4-eyelet hydrophobic (IOL) fixated to the sclera in four points by four flanges, performed between April 2022 and February 2023 by one surgeon (VDR) were included. Medical records were reviewed and the following data were recorded: age, sex, etiology of the aphakia status, comorbidities, corrected distance visual acuity (CDVA), intraocular pressure (IOP), optical coherence tomography, endothelial cell count, complications and IOL tilt.

The procedure was performed in 20 patients (mean age 81.3±9.2). Follow up was 3.6±2.4 months (range 0.5-9). Secondary implantation was performed to correct aphakia only (35% of the cases) or as part of intraocular IOL exchange (65%). Preoperative and postoperative CDVA were 1,1±0,8 and 0.55±0,5 logMAR respectively. Preoperative and postoperative IOP were 19,2±6,7 and 16,1±4,4 mmHg respectively. One patient presented cystoid macular edema. No other complications were reported. Mean preoperative and postoperative endothelial cell count were 2073±276.89 and 2012±481.47 cells/mm² respectively. The IOLs were well centered and stable and the flanges well covered. Mean vertical and horizontal IOL tilt were 0.93±0.79º and 0.73±0.59º respectively

The four-flange scleral fixation of the secondary implant of a four-eyelet foldable hydrophobic IOL using a modified Canabrava technique, provides good visual results with a low complication rate. This procedure seems to be a safe and effective method to obtain medium to long-term IOL stability and centration with minimal IOL tilt. Further studies with longer follow up and more cases are needed to confirm these preliminary results.