Re: Sánchez-Vela at al.: Reverse pupillary block after implantation of a sutureless scleral fixation Carlevale intraocular lens (Ophthalmology Retina. 2024 Oct 15:S2468-6530(24)00475-5. doi: 10.1016/j.oret.2024.10.004. Online ahead of print.)

Ophthalmology Retina, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 1, 2025

Language: Английский

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Long‐term results after sutureless intrascleral fixation of the Carlevale intraocular lens: Changes in scleral pocket thickness over time

Acta Ophthalmologica, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 27, 2025

Abstract Purpose To investigate the long‐term effects and dynamic changes in scleral thickness above T‐haptic after sutureless scleral‐fixated intraocular lens (sSFIOL) implantation using FIL‐SFF Carlevale lens. Setting Single‐centre, single‐surgeon, prospective clinical trial, Department of Ophthalmology, Medical University Vienna, Austria. Methods Thirty‐six eyes 36 consecutive patients met inclusion criteria for this post hoc analysis. Visual acuity, tilt decentration IOL, as well complications, were evaluated alongside imaging pockets during multiple time points anterior optical coherence tomography (AS‐OCT) system Tomey CASIA 2 bleb mode. The OCT scan pattern, oriented parallel to T‐shaped haptic facilitated manual analysis images measure pocket on both temporal nasal haptics. compensate distortions non‐perpendicular image acquisition, distal was also measured calculate relative thickness. For statistical evaluation, a linear mixed model used, where we corrected measurements. Results mean follow‐up period 28 ± 11 months. Measured exhibited significant decrease sides, translating an estimated annual approximately 0.03 mm ( p < 0.001). Postoperatively, best‐corrected visual acuity (BCVA) significantly improved from 0.77 0.74 logMAR preoperatively 0.41 0.60 IOL increased slightly 7.23° 3.43° 7.71° 3.70° = 0.003), while decreased 0.21 0.39 0.20 0.001) postoperatively. Conclusions Long‐term evaluation sSFIOL demonstrated improvement postoperative BCVA. However, observed thinning thickness, raising questions about its significance viability subconjunctival placement T‐haptics long term. Further studies are necessary evaluate patency pocket.

Language: Английский

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Prevention or management strategies for complications of the Carlevale intraocular lens fixation in aphakic eyes without capsular support in older patients: a systematic review

Aging advances., Journal Year: 2025, Volume and Issue: 2(2), P. 84 - 88

Published: April 8, 2025

Cataract is a major age-related eye disease. Despite the progress achieved in its management over last few decades, intraocular lens fixation options for aphakic eyes without capsular support older patients have been unsatisfactory, as they are associated with significant complications. The of cataracts and aphakia particularly important patients, who often face increased surgical risks Carlevale specially designed one-piece scleral such cases. It overcomes many limitations preexisting lenses techniques. We systematically searched literature to review main intra- postoperative complications this new lens. has favorable complication profile, these can be prevented or easily managed. clinical implications improving patients’ vision quality life, especially patients. Therefore, it holds promise becoming gold standard

Language: Английский

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Peripheral Iridectomy in Intrascleral Intraocular Lens Fixation: Preventing Reverse Pupillary Block

American Journal of Ophthalmology, Journal Year: 2024, Volume and Issue: 269, P. 471 - 481

Published: Oct. 11, 2024

Language: Английский

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Safety and efficacy of the MA60AC lens in the yamane sutureless flanged scleral fixated IOL technique

Expert Review of Ophthalmology, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 13, 2025

Language: Английский

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Current Evidence for a New Surgical Technique for Scleral Fixation: The Implantation of a Carlevale Lens, a Systematic Review

Journal of Clinical Medicine, Journal Year: 2024, Volume and Issue: 13(11), P. 3287 - 3287

Published: June 3, 2024

Background: The Carlevale lens (FIL SSF, Soleko IOL Division, Italy) is a new for suture-less scleral fixation. This paper aimed to systematically review articles on this lens, the surgical techniques used its implantation, complications and outcomes. Methods: systematic was performed following PRISMA guidelines. search string "Carlevale" AND "scleral fixation" from inception until March 2024. For completeness, either case-control studies, case reports or series written in English were included. authors Newcastle-Ottawa scale studies JBI Critical Appraisal Checklist series. Results: Twenty-nine Scleral fixation with can be by creating flaps or, alternatively, using pockets. two sclerotomies must diametrically opposed, are preferably created 25-gauge trocars. A pars plana vitrectomy should every time, design of suitable self-anchoring sclera; most accredited strategy achieve avoid sutures. There only few intraoperative postoperative reported; vitreous hemorrhages frequent events, while relevant hemorrhages, cystoid macular oedema transient variations intraocular pressure. Excellent results have been obtained terms BCVA, centration stability, mean pressure, spherical equivalent, separation between anterior posterior chamber distance structures. Conclusions: foldable hydrophilic has shown good effectiveness, stability intra post-operative complications.

Language: Английский

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Secondary intraocular lenses: Reversing to move forward

Clinical and Experimental Ophthalmology, Journal Year: 2024, Volume and Issue: 52(6), P. 611 - 613

Published: Aug. 1, 2024

Aphakia may be caused by inherited zonulopathies with dislocation of a crystalline lens, trauma, complicated cataract surgery, planned lensectomy without insertion an intraocular lens (IOL), explantation faulty, incorrect or problematic IOL spontaneous late subluxation IOL. The incidence the last group is rising increasing number ageing pseudophakic patients. variety techniques to manage aphakia in absence capsular support has expanded two decades. These can divided into four main groups: anterior chamber (AC-IOL), iris-fixated IOL, scleral tunnelled and sutured evolution these been iterative process, improvements design, suture material surgical technique advancing field. Anterior placement AC-IOL oldest described that requires intact iris uveitis. Advantages are its simplicity, stability established history use. Disadvantages potential for corneal endothelial dysfunction (reduced open haptic styles), trauma causing uveitis-glaucoma-hyphaema (UGH) syndrome cystoid macular oedema (CMO), limited sizing options should determined white-to-white diameter need peripheral iridotomy (PI) prevent pupillary block. Because IOLs all made non-foldable polymethylmethacrylate (PMMA) material, larger wound (approximately 5.5 mm depending on model) required, which increase risk complications including prolapse, hypotony astigmatism. Like AC-IOLs, require healthy iris. They claw. Iris-sutured commonly use 10-0 polypropylene (PROLENE®) fixation using McCannel slip knot. A dislocated 3-piece reused exchange suturing existing most common claw Artisan® Model 205 (Ophtec BV). This placed posterior (retropupillary) also PMMA requiring (the standard body 5.4 mm). Cosmesis improved retropupillary placement, although UGH CMO still occur. In addition, poor lead misshapen ('cats-eye') pupil occur if haptics disenclave from Scleral tunnelling three categories: haptics, Canabrava Carlevale. Tunnelling as early 1980s,1 but increased popularity 2000s due advances technique. manouevre advantage potentially utilising exchange. 2008, Agarwal et al.2 fibrin glue fixate externalised beneath 180-degree opposed limbal-based flaps. 2007, Gabor al.3 utilised 2.0–3.0 tunnels fashioned ab externo sharp 24-gauge cannula secure 1.5–2.0 limbus, thus avoiding 2017, Yamane al.4 introduced cautery melt ends creating flange was pushed subconjunctivally tunnel. provided greater reduced slippage back through Variations tunnel include 30-gauge TSK ultra-thin-walled needles (Tochigi Seiko, Tochigi, Japan) reduce size slippage, 27-gauge vitrectomy cannulae IOLs, have more flexible forgiving polyvinylidene fluoride (PVDF) such CT LUCIA® 202 (Carl Zeiss Meditec AG) Focus Acrylic 600™ (eyePx). 2020, al.5 popularised 5-0 ends, similar method performed manipulated threading it up 26-gauge needle. even single-piece do not PVDF haptics. Flanges at both ends. any eyelet created punch (non-PMMA IOL). Four-point extra achieved when used four-eyelet scenario, 6-0 29-gauge needle recommended. It help one end partially subluxed. FIL SSF Carlevale (Soleko™ Division, Italy) novel foldable acrylic designed fixation.6 T-shaped harpoons each end, buried intrascleral pockets. advantages being aphakic management toric version available correcting pockets, trans-scleral harpoon breaking opacification hydrophilic material. sutureless over suture-related inflammation, exposure breakage dislocation. Potential disadvantages technical difficulty unreliability, tilt, poorer stability. flaps, Hoffmann pockets subconjunctival suturing. 1991, Lewis7 underneath triangular became classic many years had flap-related complications. 2006, Hoffman al.8 corneal-scleral pocket hide suture, conjunctival dissection introduction newer models led Initially eyelets CZ70BD (Alcon Laboratories Fort Worth, Texas, USA) were used; however, rigid means large wounds required implantation. Foldable since entered market, allowing entry small 2.2 mm, thereby minimising leakage, hypotony, astigmatism extent LuxGood™ (Bausch + Lomb), Micropure 1.2.3 (BVI Medical) Akreos AO60 Lomb) four-looped gives them only enVista MX60 four-point fixation. Both hydrophobic advantageous AO60, hydrophilic, therefore higher opacification.9 MX60, like versions. Another advancement GORE-TEX® (W.L. Gore & Associates, Elkton, Maryland, CV-8 (equivalent 7-0 gauge). high tensile strength, minimal memory low pro-inflammatory properties, make preferable suturing.10 combination currently popular choice, peritomies, flaps pockets.11 decision choose needs highly personalised. Key considerations include: whether removed, explanation sutured, health conjunctiva (which makes avoidance peritomy preferable), disease glaucoma (when approach favoured), pathology uveitis (contraindicating IOL), presence segment (necessitating vitrectomy), requirement vitreous tamponade affect migration) particular power (spherical and/or toric). secondary breakage, dislocation, decentration, decompensation, glaucoma, uveitis, CMO, endopthalmitis, haemorrhage retinal detachment. Pupil block complication well where occluded blood, viscoelastic leading bombé eventual angle closure. Reverse (RPB), less studied. this there concave bowing iridolenticular touch. functions flap valve, aqueous flow pressure builds up, opposite direction. Left untreated, pigment dispersion syndrome, CMO.12 RPB treated PI intraoperatively lifting off lens. question arises—when necessary perform prophylactic time implantation? All AC-IOLs accompanied PI. Although manufacturer recommendation PI, remains debatable given vaulted profile, especially implanted location. Except now rarely earlier, off-label techniques, come recommendations, recommended their procedure. anterior, RPB.6 comes either angulated slant vaulting keep optic away pupil. edition journal, Schranz al.12 endeavoured diagnose OCT (AS-OCT) following types IOLs: Scharioth, Yamane, techniques. found almost third associated some point during 3-year follow-up, median surgery first detected RPD 2 years. prompted authors recommend iridectomy patients undergoing fixation, risks chronic dispersion. Complicating argument multitude variables influence development RPB, design shape flexibility, implantation distance vitrectomy, eye anatomy refraction retained viscoelastic. However, did find axial length choice benign procedure IOP spikes, dispersion, haemorrhage, pseudopolycoria, visual dysphotopsiae, diplopia damage. Whether AS-OCT measurements reliably correlate clinically meaningful uncertain. Clinically diagnosed rare event modern identifying case report patient who underwent value study opens new discussion regarding importance previously recognised. Further research verify findings determine valid IOLs. As common, keeping historical important best way innovate materials become available. Always remember check your reverse mirror before moving forward. None. declare no conflict interest.

Language: Английский

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Sekundäre Linsenimplantation

Augenheilkunde up2date, Journal Year: 2024, Volume and Issue: 14(04), P. 321 - 336

Published: Nov. 1, 2024

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Refractive Outcome, Lens Power Calculation, and Surgically Induced Astigmatism After Four-Flanged Intrascleral Intraocular Lens Fixation

Journal of Refractive Surgery, Journal Year: 2024, Volume and Issue: 40(12)

Published: Dec. 1, 2024

Purpose To evaluate the refractive prediction error of common intraocular lens (IOL) power calculation formulas in patients who underwent intrascleral IOL fixation using four-flanged technique. Methods This prospective, longitudinal, single-site, single-surgeon study's setting was Department for Ophthalmology and Optometry, Medical University Vienna, Austria. Patients received implantation via technique were followed up to 3 months after operation. Refraction measured Early Treatment Diabetic Retinopathy Study visual acuity test at 4 m. Lens decentration, tilt, aqueous anterior chamber depth evaluated segment optical coherence tomography. The SRKT, Holladay 1, Hoffer-Q used assess (PE) absolute (AE). Correlations between axial length, keratometry, white-to-white distance subsequently evaluated. Results A total 28 eyes examined this study. application all resulted a hyperopic PE (SRKT: 0.35 ± 0.86 diopters [D], 1: 0.36 0.78 D Hoffer-Q: 0.37 0.73 D). There no variation different discovered ( P > .05). AE within 0.50 54% 61% 1.00 79% eyes, depending on formula used. Furthermore, Cochrane's Q detected significant distinctions each demonstrated correlation length < estimates ranged from −0.25 D/mm −0.39 D/mm, subject applied formula. Conclusions study demonstrates that scleral yields reliable outcomes. closest zero formula, although there statistically difference compared other formulas. Axial emerged as most pertinent factor PE. Short more outcome, whereas longer myopic outcome than intended. shift due standardized surgical with an externalization haptics 2.5 mm behind limbus resulting consistent across eye lengths, coupled reduction or increase macula, which is dependent eye. [ J Refract Surg . 2024;40(12):e985–e993.]

Language: Английский

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Sekundäre Linsenimplantation

Klinische Monatsblätter für Augenheilkunde, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 6, 2024

Unter sekundärer Kunstlinsenimplantation versteht man das Einsetzen einer Intraokularlinse nach vorausgegangenen Operation mit resultierender Aphakie oder insuffizienter Stabilität des Kapselhalteapparats. Durch die Entwicklungen der modernen Kataraktchirurgie haben sich verschiedene Methoden sekundären etabliert, welche patienten- und situationsspezifisch sorgfältig ausgewählt werden sollten.

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