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Three-Year Follow-up of a 2-Year-Old Patient with Scleral-Fixated Carlevale Intraocular Lens Implantation

2022; Volume: 53; Issue: 5 Linguagem: Inglês

10.3928/23258160-20220413-01

2325-8179

Konstantinos Ananikas, Agathi Kouri, Panagiotis Tsoutsanis, Giorgos Chatzilaou, Stratos Gotzaridis,

Corneal surgery and disorders

Correspondence freeThree-Year Follow-up of a 2-Year-Old Patient with Scleral-Fixated Carlevale Intraocular Lens Implantation Konstantinos Ananikas, MD, FEBO, ; , MD, FEBO Agathi Kouri, MD, FRCS, ; , MD, FRCS Panagiotis Tsoutsanis, MD, ; , MD Giorgos Chatzilaou, MD, ; and , MD Stratos Gotzaridis, MD, FASRS, , MD, FASRS Konstantinos Ananikas, MD, FEBO Address correspondence to Konstantinos Ananikas, MD, FEBO, My Retina Athens Eye Centre, 66 Vassilisis Sophias Avenue, Athens, Greece 11528; email: E-mail Address: [email protected]. , Agathi Kouri, MD, FRCS , Panagiotis Tsoutsanis, MD , Giorgos Chatzilaou, MD , and Stratos Gotzaridis, MD, FASRS Published Online:May 01, 2022https://doi.org/10.3928/23258160-20220413-01PDF ToolsAdd to favoritesDownload CitationsTrack CitationsCopy LTI LinkHTMLPDF ShareShare onFacebookTwitterLinkedInRedditEmail SectionsMoreIntroductionDear Editor,Aphakia, or inadequate capsular support, in children often occurs as a result of ectopia lentis due to systemic disorders such as Marfan syndrome, Weil-Marchesani syndrome, and homocystinuria. Additionally, it presents as a follow-up consequence of trauma and lensectomy due to childhood cataract.1In a study by Gotzaridis et al,2 five eyes of four patients between 2 and 10 years old were included, in which the novel Carlevale lens was inserted for various aphakia-related issues. One of the patients was 2 years old at the time of the surgery. To the best of our knowledge, this is the case with the youngest patient published so far regarding a Carlevale intraocular lens (IOL) implantation. The aim of this letter is to provide a 3-year follow-up update of the long-term outcomes of this novel scleral-fixated IOL.According to the patient's history, the child had an earlier lens extraction with IOL implantation procedure in another center due to unilateral congenital cataract. The patient was referred to our practice for a second opinion regarding removal of the IOL as it had a significant tilt because of inadequate capsular support. The best corrected visual acuity (BCVA) was counting fingers (CF).A 25-gauge three-port core vitrectomy (posterior vitreous detachment [PVD] was extremely difficult and subsequently dangerous to be performed until far periphery) and posterior capsule IOL removal through a scleral tunnel were performed. At the end of the procedure, the Carlevale scleral-fixated IOL was placed at the 12- and 6-o'clock positions, 1.5 mm away from the limbus, through the same scleral tunnel. The power of the lens was 26.00 diopters, and the biometry measures were axial length = 20.45 mm, K1 = 8.31 mm, and K2 = 7.77 mm. The IOL power was calculated from the SRK II formula with the A-scan using the A-constant of 118.5 for the IOL, as suggested by the manufacturer.As mentioned in the first publication, the operation was uneventful, and the 7-month postoperative follow-up did not reveal retinal detachment or any other retinal pathology. The IOL was well centered and the T-shaped haptics were in position without any signs of erosion, exposure, or local inflammation. The cornea remained clear through the end of the follow-up period and the IOP was normal. The BCVA improved from CF to 0.2 decimal.Concerning the amblyopia management, the patient's parents were instructed to follow a regimen of part-time occlusion on the non-operated eye 6 hours per day and attend regular appointments in our practice every two to three months.Up to the last visit, three years following Carlevale implantation, no major complication had occurred. Specifically, no retinal pathology arose, and the IOP has been within normal limits. The cornea remained clear, and the anterior chamber showed no signs of inflammation at any of the follow-up visits. The optic of the IOL was well-centered and untilted, and the T-shaped haptics remained in place (Figure 1). In our opinion, the acrylic material and the elastic architecture of the haptics permit them to stretch or compress without causing significant stress to the scleral and conjunctival tissue. Thus, despite the lens being manufactured and used for adults as previously mentioned, it could also be a great option for use in cases in children. Further, the scleral flaps successfully prevent any long-term erosion, exposure, or inflammation of the conjunctiva. The postoperative tilt was assessed using the technique described by Yamane et al.3Figure 1. T-shaped haptics under the sclera.Finally, concerning visual acuity, the patient had a BCVA of 0.17 decimal with glasses with refraction correction of +5.00 sphere and −2.00 cylinder × 60°. Unfortunately, because of the COVID-19 pandemic, several follow-up visits could not be completed, and the parents did not adhere to the daily amblyopia treatment.Konstantinos Ananikas, MD, FEBO; Agathi Kouri, MD, FRCS;Panagiotis Tsoutsanis, MD; Giorgos Chatzilaou, MD; andStratos Gotzaridis, MD, FASRS1.Cheung CS, VanderVeen DK. Intraocular lens techniques in pediatric eyes with insufficient capsular support: complications and outcomes. Semin Ophthalmol. 2019; 34(4):293–302. 10.1080/08820538.2019.1620809 PMID:31138081 Crossref MedlineGoogle Scholar2.Gotzaridis S, Georgalas I, Papakonstantinou Eet al.. Scleral fixation of Carlevale intraocular lens in children: a novel tool in correcting aphakia with no capsular support. Ophthalmic Surg Lasers Imaging Retina. 2021; 52(2):94–101. 10.3928/23258160-20210201-06. PMID: 33626170. LinkGoogle Scholar3.Yamane S, Inoue M, Arakawa A, Kadonosono K. Sutureless 27-gauge needle-guided intrascleral intraocular lens implantation with lamellar scleral dissection. Ophthalmology. 2014; 121(1):61–66. 10.1016/j.ophtha.2013.08.043 PMID:24148655 Crossref MedlineGoogle Scholar Previous article FiguresReferencesRelatedDetails Request Permissions InformationCopyright 2022, SLACK IncorporatedPDF downloadAddress correspondence to Konstantinos Ananikas, MD, FEBO, My Retina Athens Eye Centre, 66 Vassilisis Sophias Avenue, Athens, Greece 11528; email: kon.[email protected]com.From My Retina Athens Eye Centre, Athens, Greece (KA, PT, GC, SG); and the Department of Ophthalmology, P. & A. Kyriakou Children's Hospital, Athens, Greece (AK).Financial disclosure: The authors have no relevant financial relationships to disclose.