Reverse Pupillary Block After Implantation Of A Sutureless Scleral Fixation (Sff) Iol (Carlevale, Soleko)

Published 2025 - 43rd Congress of the ESCRS

Reference: PP11.11 | Type: Free paper | DOI: 10.82333/xdyv-7104

Authors: Laura Sanchez Vela* ¹ , Jaume Rigo Quera ¹ , Olivia Pujol Carreras ¹ , Manuel Amilburu Pérez ¹ , Marta Castany Aregall ¹

¹Vall d'Hebron University Hospital,Barcelona,Spain

Purpose

To describe the incidence, complications and management of reverse pupillary block (RPB) after implantation of Carlevale IOL.

Setting

Multicenter, retrospective, cross-sectional study.

Methods

Out of a sample of 128 patients that had undergone Carlevale IOL implantation, 19 patients were found to present RPB, who were evaluated and treated with laser peripheral iridotomy (LPI).

Demographic data (age, gender), data on preexisting medication, axial length (Zeiss IOLMaster 500 and Zeiss IOLMaster 700), presence of pseudoexfoliation material, presence of reverse pupillary block (Anterior segment swept-source SS-OCT Anterion, Heidelberg Engineering), presence of macular edema (Irvine Gass syndrome, OCT Spectralis, Heidelberg Engineering), anterior chamber depth before and after LPI, best corrected visual acuity before and after LPI and intraocular pressure before and after LPI were analyzed.

Results

An incidence of RPB of 14.8% was found. The prevalence of pseudoexfoliation syndrome was 21.1% and 42.1% of patients presented an axial length >24.00 mm. Mean pre-LPI ACD was 4.78

± 0.465 mm and post-LPI was 4.23 ± 0.404 mm, a statistically significant increase of 0.54 (p=0.000, IC 95% 0.26-0.83) mm of ACD was observed. There were no differences between pre- and post- LPI BCVA. Pre-LPI IOP was 17.10 (range 12-34) mmHg and post-LPI IOP was 14.47 (range 10-21) mmHg, (p= 0.391). Cystic macular oedema (Irvine Gass) was identified in 4 out of 19 patients, reporting an incidence of 21.1% in RPB cases.

Conclusions

Reverse pupillary block is a relatively common complication after Carlevale lens implantation, which may be associated with an increase of macular oedema incidence but does not clearly correlate an increase of intraocular pressure. Our hypothesis is that indentation of the sclera induces a posterior rotation of the peripheral iris, causing RPB. Our results encourage to look over the Carlevale IOL implantation technique to consider a routinely intraoperative surgical peripheral iridotomy to avoid RPB and its further complications.