Reverse Pupillary Block After Implanting A Sutureless Scleral Fixation Carlevale Intraocular Lens

To assess the postoperative outcomes of implanting a sutureless scleral fixation Carlevale intraocular lens (IOL) and to discuss reverse pupillary block as a possible complication.

Department of Ophthalmology, Mútua Terrassa University Hospital, Terrassa, Barcelona, Spain.

A 71-year-old patient presented with a spontaneous unilateral inferior subluxation of the IOL and a vitreous wick in the anterior chamber. The subluxated IOL was explanted, a sutureless scleral fixation Carlevale IOL was implanted through the creation of scleral flaps, and a posterior vitrectomy was performed. Pre and postoperative refractive outcomes and intraocular pressure (IOP) were assessed. Optic plate position and tilt were evaluated using ultrasound biomicroscopy (UBM). Papillary and macular OCT were also done.

Postoperative distance visual acuity improved. IOP remained within normal limits and no ocular hypertensive peak was detected. The eye presented an extremely deep anterior chamber, as anterior chamber depth was 4,51mm. Carlevale IOL haptics were well fixed in the sclera. Iris showed a concave configuration. UBM detected that IOL contacted the posterior surface of the iris, both vertically and horizontally. Laser peripheral iridotomy was performed, after which the iris recovered a normal position. Results from papillary and macular OCT were within normal range. 

Carlevale IOL represents a suitable and effective option for managing aphakia and IOL luxation in absence of capsular support. The need to perform iridotomies prior to surgery or, if not, intraoperative iridectomies should be evaluated to prevent a possible reverse pupillary block. When reverse pupillary block is already established, laser peripheral iridotomy is a useful procedure.