SCLERAL-FIXATED TORIC LENS AS A SECONDARY IMPLANT FOR THE TREATMENT OF APHAKIA AFTER A COMPLICATED INTRAOCULAR LENS EXPLANT

A 74-year-old woman with perimetric glaucoma with a 5.14 D corneal cylinder underwent a conventional cataract surgery with monofocal lens (Micropure 123) implant in her right eye. Six weeks after the surgery, a refractive surprise was noted, being the best corrected visual acuity 0.32/1.00 decimal (logMAR 0.5; Foot 20/63).

Hospital del Mar, Cornea department. Barcelona

An intraocular lens (IOL) explant was planned. Iris hooks were needed due to intraoperative floppy iris syndrome. Dissection of the IOL from the anterior and posterior capsulas with viscoelastic and spatula was performed. Both haptics of the lens were fibrosated and fused with the capsulas. During IOL luxation manuevers to the anterior chamber, disinsertion of the capsular bag occurred. The IOL was cut in half and both IOL and capsular bag were removed and anterior vitrectomy was performed, leaving the patient afaquic. A second time surgery was performed with sutureless scleral fixation toric lens (carlevale) as a secondary implant. Biometric K1 was 41.16 D; K2 46.30 D. A carlevale +20.0 D spherical +8.0 cylinder at 30º axis was implanted. 

Postoperative refractive results were very satisfying, being refraction -0,25 -0,50 125º, uncorrected visual acuity 0.80 /1.00 decimal (logMAR 0.10; Foot 20/25) and best corrected visual acuity 1.0 decimal (logMAR 0; Foot 20/20)

plate-haptic and plate-loop haptic design lenses tend to have earlier fibrosis to the capsula than C-loop models. Close post operative monitoring is required to better assess cases which will potentially need an IOL exchange surgery, which is a complex surgery that can potentially end up in afaquia. The Carlevale is the only toric sutureless scleral fixated lens available and represents a highly favorable choice for afaquic patients without capsular bag support and with high astigmatism, resulting in optimal refractive results.