In vivo evaluation of a 1-piece foldable sutureless intrascleral fixation intraocular lens using ultrasound biomicroscopy and anterior segment OCT

Purpose: To evaluate the optic plate and haptics of a specially designed sutureless intrascleral-fixated intraocular lens (IOL) using ultrasound biomicroscopy and anterior segment optical coherence tomography (AS-OCT). Setting: Department of Ophthalmology, San Marino Hospital, Republic of San Marino. Design: Retrospective observational case series. Methods: Eyes that underwent intrascleral fixation with IOL implantation (Carlevale) were included. Preoperative and postoperative refractive outcomes were reported. Optic plate tilt and haptics position were assessed with ultrasound biomicroscopy, whereas intrascleral plug depth and conformation were evaluated with AS-OCT. Results: The study comprised 10 aphakic eyes. Postoperative visual acuity improved in all patients. At postoperative month 3, 3 eyes (30%) had a vertical tilt of more than 100 mm, whereas no horizontal tilt was observed in any patient. The mean vertical intraocular tilt was 0.19 +/- 0.22 mm. Of 20 haptics, 13 (65%) passed through the ciliary sulcus, 4 (20%) posterior to the ciliary body, and 3 (15%) through the ciliary body. AS-OCT scans showed a mean intrascleral plug depth of 247.20 +/- 62.82 mm in the nasal sector and 265.50 +/- 30.11 mm in the temporal sector, with adequate integration of the T-shaped plugs in the scleral tissue. Conclusions: This secondary IOL showed good intraocular stability and safe haptics fixation, making it suitable for the intrascleral fixation technique. The specific foldable design results in a low predisposition to optic plate tilt and haptic torsion. In long eyes, the sulcus-to-sulcus distance should be carefully evaluated preoperatively because the flexible structure of the IOL could be subjected to excessive stretching. J Cataract Refract Surg 2021; 47:316-322 Copyright (c) 2021 Published by Wolters Kluwer on behalf of ASCRS and ESCRS

Automated summary

The study evaluated the optic plate and haptics of a specially designed sutureless intrascleral-fixated intraocular lens using ultrasound biomicroscopy and anterior segment optical coherence tomography. The IOL showed good intraocular stability and safe haptics fixation postoperatively, making it suitable for intrascleral fixation technique. The foldable design resulted in a low predisposition to optic plate tilt and haptic torsion.