Endoscope-Assisted Carlevale Lens Implantation in Patients Without Capsular Support: A Novel Surgical Approach to Ensure Correct Lens Positioning.

PURPOSE: To describe endoscope-assisted Carlevale intraocular lens (IOL) implantation. METHODS: Twelve eyes underwent posterior vitrectomy combined with Carlevale IOL implantation and endoscopy in a single procedure, using a technique developed by the authors. Transscleral incisions were performed under direct visualization of the sulcus using the endoscope, and the final lens position was checked at the end of each intervention. The main outcome was to determine the exact position of all lens fixation points. RESULTS: All plugs were correctly placed in the sulcus, but in seven eyes (58.3%), at least one of the closed-loop haptics was folded over the ciliary body. Repositioning was performed during the same procedure. Given that each IOL has four closed-loop haptics, the incidence of this complication was 23% (11/48). CONCLUSION: Blind implantation of Carlevale IOL may cause a high incidence of haptic malpositioning. Because the sulcus and the ciliary body are not visible under the microscope, endoscopy is the only way to ensure correct lens implantation. This new technique ensures that all lens fixation points are correctly placed by the end of surgery, avoiding complications such as decentration or tilting of the IOL, damage to the iris or the ciliary body, and uveitis.

Ab externo approach to treat bilateral haptic extrusion secondary to scleral erosion of an intrascleral sutureless-fixated intraocular lens.

Surgical management of haptic extrusion of an intrascleral sutureless-fixated intraocular lens (IOL) (FIL-SSF Carlevale, Soleko) by repositioning the IOL without lens extraction was reported. The patient presented an early extrusion of both IOL harpoons just 4 weeks after the initial surgery. New scleral flaps were created 30 degrees superior to the nasal harpoon and 30 degrees inferior to the temporal harpoon so that the IOL was rotated clockwise. Each haptic was grasped with a 25-gauge forceps and introduced into the vitreous cavity and regrasped with another forceps through a new port, 1.5 mm posterior to the limbus, and underneath a new scleral flap. The Carlevale IOL is specially designed for sutureless intrascleral fixation with excellent anatomic and visual results but may also show specific complications. To the authors' knowledge, this is the first report on how to efficiently manage harpoon erosion using this simple technique.

OUTCOME OF ACUTE NONTRAUMATIC VITREOUS HEMORRHAGE IN HEALTHY PATIENTS.

PURPOSE: To compare outcomes in dense vitreous hemorrhage versus mild vitreous hemorrhage due to nontraumatic posterior vitreous detachment. METHODS: We compared 315 eyes, divided into 2 patient groups, one with dense and the other with mild vitreous hemorrhage. The main outcome measures were final mean best-corrected visual acuity, number of retinal tears, number of retinal detachments, and the number of pars plana vitrectomy and/or scleral buckle surgeries. RESULTS: In 33.4% of the patients, posterior vitreous detachment without complications was found. Retinal breaks after posterior vitreous detachment were found in 59% of the eyes. Rhegmatogenous retinal detachment was principally treated with pars plana vitrectomy and scleral buckle. In nonvisible fundus hemorrhage group, 44.4% of the patients underwent vitrectomy. In visible fundus hemorrhage group, 9.52% of the patients underwent pars plana vitrectomy. The mean final visual acuity was 20/25, without significant difference between groups (P = 0.064). CONCLUSION: Acute, spontaneous, nontraumatic posterior vitreous separation with vitreous hemorrhage is associated with a high incidence of retinal complications. Close follow-up is necessary. We did not find significant differences in final visual acuity neither between the two groups nor among the treatments.