Four-Flanged Scleral Fixation Of A Four-Eyelet Foldable Hydrophobic Intraocular Lens With A Modified Canabrava Technique: Surgical Outcomes According To Vitreous Management

To evaluate safety and efficacy of the four-flanged scleral fixation of a four-eyelet foldable hydrophobic intraocular lens IOL with a modified Canabrava technique to correct aphakia in the absence of capsular support and to compare the outcomes and complications of cases performed in combination with limbal anterior vitrectomy versus those performed with posterior pars plana vitrectomy

Tertiary referral public hospital Department of Ophthalmology Complexo Hospitalario Universitario A Coruña, Spain

Retrospective study. All cases of four-flanged scleral fixation of a four-eyelet IOL performed between April 2022 and January 2023 were searched in the surgical database and included in the study. Medical records were reviewed and the following data collected: age, sex, eye, comorbidities, preoperative and postoperative corrected distance visual acuity (CDVA), intraocular pressure, endothelial cell count, spherical equivalent, macular optical coherence tomography and intraoperative and postoperative surgical complications. Eyes were divided according to the strategy used for vitreous management into a pars plana vitrectomy (PPV) group and anterior vitrectomy (AV) group. Visual outcomes and complications were compared between groups

72 cases were identified: 39 were included in AV and 33 in PPV. Mean age was 80±10.5 years. Mean follow up was 7.5±4.4 months (1-21months). CDVA improved significantly in both groups (p<0.001) without significant difference in postoperative CDVA between them (p=0.659). IOP significantly decreased in both groups (p=0.054 in AV and p=0.019 in PPV), without significant differences IOP between them (p=0.153). Complications: cystoid macular edema in 23.1% and 30.3% eyes in AV and PPV respectively (p=0.594), ocular hipertension in 12.82% and in 6.6% eyes, retinal detachment one eye in each group, choroidal detachment 2 eyes in PPV, sterile vitritis 1 eye in AV. No complications of internalizacion or externalization of flanges were detected.

Four-flanged scleral fixation of a four-eyelet foldable hydrophobic IOL is safe and effective for the management of aphakia and lens/IOL dislocation or subluxation. No significant differences were found between the group with anterior vitrectomy as compared with the group performed with pars plana vitrectomy regarding visual acuity outcomes, or postoperative complications. Further studies with longer follow up are needed.

FINANCIAL DISCOUSURE: The authors have no financial or industrial interest in the matter or have received remuneration from any company mentioned.