New Sutureless, Scleral-Fixated Intraocular Lens (Carlevale, Soleko) Implantation Combined With Descemet Stripping Automated Endothelial Keratoplasty: An Innovative Surgical Approach

Abstract

Purpose: To describe a novel technique of combined Descemet stripping automated endothelial keratoplasty (DSAEK) with implantation of a new scleral fixated, sutureless, posterior chamber intraocular lens (IOL) (Carlevale, Soleko). Methods: A new surgical technique description. Results: We describe a novel surgical approach, namely combining implantation of a new scleral-fixated sutureless posterior chamber IOL with DSAEK for the management of IOL dislocation and corneal endothelial decompensation. The existing, dislocated IOL was removed, and 2 scleral radial incisions were performed 180 degrees apart. Two partial thickness scleral pockets were created along each scleral radial incision, followed by a 23 G sclerotomy. The IOL was placed in the posterior chamber by using 23 G vitreoretinal forceps, and each plug was secured under the 2 pockets. A standard DSAEK procedure was then performed. Four months postoperatively, the corneal graft was attached and clear. The Carlevale IOL was well positioned, and an improvement in the patient's vision was observed. Conclusions: Combining implantation of a new scleral fixated foldable sutureless IOL (Carlevale, Soleko) with DSAEK could represent a viable and effective option for patients with IOL dislocation or aphakia, accompanied by corneal endothelial dysfunction.

Outcomes of Secondary Intraocular Lens Implantation and Descemet Stripping Endothelial Keratoplasty—Comparing Staged Versus Combined Surgical Approach

“…4,7–11 Some authors have previously described the outcomes of combined DSEK with IOL techniques. 2,12–18…”

“…4,[7][8][9][10][11] Some authors have previously described the outcomes of combined DSEK with IOL techniques. 2,[12][13][14][15][16][17][18] Frequently, the decision to perform a staged versus combined approach is left to the clinician's discretion. The advantage of performing secondary IOL implantation as separate surgery may afford better accuracy in obtaining desired refractive outcomes because there are anticipated corneal keratometry changes and hyperopic shifts after DSEK.…”

Scleral Fixation of Akreos AO60 Intraocular Lens Using Gore-Tex Suture: An Eye on Visual Outcomes and Postoperative Complications

“…Besides being devoid of suture-related complications, Carlevale IOL has been reported to have a great stability profile with no IOL displacement or haptic breakage, providing good refractive outcomes. Moreover, its innovative design with two small and flexible plugs at the end of each haptic, anchoring the IOL to the scleral tissue, theoretically reduces surgical complexity and time [ 11 , 12 ].…”

“…IOP was measured by Goldmann applanation tonometry. Hypotony was defined as intraocular pressure (IOP) of 5 mmHg or less, and hypertension was defined as an IOP of 25 mmHg or more, at any postoperative visit, following previous similar definitions in other studies [ 3 , 12 , 13 ]. Corneal edema was defined as de novo postoperative edema persisting for more than 1 week.…”

“…Recently, new foldable IOLs such as the Carlevale IOL have been designed for scleral fixation, allowing small incision sutureless implantation with great IOL stability and promising results [ 11 ]. In specific cases, this technique can be safely combined with other surgical procedures, as demonstrated by Kymionis et al who performed a combined DSAEK with the scleral implantation of a Carlevale IOL in a patient with bullous keratopathy and a dislocated IOL [ 12 ]. Still, high intraocular pressure (IOP), cystoid macular edema, and iris capture by the IOL optic are reported complications with sutureless scleral fixation IOLs [ 11 ].…”