Outcomes of a Secondary Sutureless Scleral Fixation of an Intraocular Lens after Penetrating Ocular Trauma

Author: Edgar Lopes (Portugal)

Co-authors: Edgar Lopes, Catarina Mota, Afonso Murta, Catarina Xavier, Miguel Vieira, Marco Dutra Medeiros

Purpose

To assess the outcomes in a case of ocular penetrating trauma subjected to two vitreoretinal surgeries for treatment of complications and sutureless scleral fixation (SSF) of a mono-piece foldable hydrophobic acrylic Carlevale lens (Soleko, Italy).

Setting/Venue

Ophthalmology Department, Central Lisbon University Hospital Center.

Methods

Retrospective case report.

Results

A previously healthy 61-year-old male presented to the emergency department (ED) with a full-thickness corneal laceration of the left eye caused by penetrating trauma. There was concomitant uveal tissue prolapse and a grade II hyphema. Best-corrected visual acuity (BCVA) was hand motion. Primary repair of the corneal laceration was performed in the emergency department. In the immediate postoperative period, the patient developed a grade IV hyphema. Ocular ultrasound showed a choroidal detachment with accompanying vitreous and preretinal hemorrhage; retinal detachment was not present. He underwent pars plana vitrectomy (PPV) combined with phacoemulsification; due to inadequate capsular support, lens implantation was delayed and the patient remained aphakic. On follow-up, two superior retinal tears with an inferior retinal detachment were noted; the patient underwent a second PPV with vitreous base shaving, endolaser of two retinal defects at 13 and 3 hours, and gas tamponade with sulfur hexafluoride (SF6). A secondary SSF of a Carlevale Lens was performed; the intraocular lens (IOL) remained anatomically stable.

Conlusions

Penetrating ocular trauma can severely compromise visual acuity, and although primary surgical management can restore visual acuity to some degree, multiple procedures may be required to treat the complications. The anterior segment anatomy may be severely disrupted, and in cases where there is inadequate capsular support, a secondary IOL may be fixed to the anterior chamber angle, iris, or sclera. Secondary SSF of the IOL using a Carlevale Lens represents a valid option for the management of aphakia without capsular support after penetrating ocular trauma.

Financial Disclosure

None