Optimal use of the transscleral plugs–fixated IOL

Le résumé fourni par la source

It was with great interest that we read the article by Barca et al. regarding the use of a Carlevale intraocular lens (IOL) for scleral fixation.1 The authors presented their results of a prospective, observational case series using a scleral-fixated IOL. They included eyes with aphakia and inadequate capsular support of various etiologies. Did the authors include patients with coexistent macular disease or previous retinal surgery? In addition, how many of the patients with dislocated bag/IOL preoperatively had pseudoexfoliation? Intraoperatively, the authors performed a vitrectomy in all patients. Was posterior vitreous detachment induced in cases where it was not present? The authors noted that, in 2 eyes, pigment dispersion with anterior segment optical coherence tomography findings of reverse pupil block was noted 1 week postoperatively, and Nd:YAG peripheral iridotomy was sufficient to restore the physiological iris profile. As a result, the authors started performing surgical iridectomy routinely during the primary procedure. Did these patients with the pigment dispersion show evidence of intraocular pressure elevation? Is it really necessary to perform iridotomy in all patients? It is known that marked aqueous streaming through the iridotomy window against the corneal endothelium has been shown to cause mechanical stress to the corneal endothelium.2 This could lead to further damage to the cornea in the long term, and we believe it is important to try to avoid this routine procedure if it is not necessary. In addition, in some cases, iridotomy could possibly lead to vitreous hemorrhage that could delay visual rehabilitation in these patients. It is interesting that, in these patients with posterior iris bowling, no IOL capture or IOL tilt was demonstrated. In addition, the authors advocate that the more forgiving manipulation of the IOL plugs (haptics) could be the reason for the lower degree of IOL tilt observed in these cases. We agree and would like to add to that the importance of the design of the IOL with the large flaps attached to the plugs. These act as an additional preventative mechanism for tilt or iris capture and demonstrate the advantage of using a specially designed IOL for scleral fixation. Finally, we would like to note that Veronese et al. published similar results in 4 patients who underwent vitrectomy and Carlevale IOL placement.3 The authors used a slightly different technique, using 25-gauge trocars to create the scleral tunnel instead of scleral flaps. Of course, further studies are needed to evaluate optimal surgical refinements and long-term follow-up results.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.