Outcome of secondary intraocular lens implantation-conventional 23- vs. modified 27-gauge vitrectomy port anchor fixation
Reviewed by Sofia Rokerya

This retrospective case study series evaluated the outcome of a secondary intraocular lens (IOL) implantation technique of a Carlevale IOL (Soleko IOL Division, Italy) with either a conventional 23- or a modified 27-gauge (-g) vitrectomy port used as anchor fixation. Two-hundred-and-eighty-two eyes of 282 patients (123w / 158 m), after sutureless scleral technique and IOL fixation with implantation of a Carlevale IOL, were included in the study. Patients were divided into two groups: conventional 23-g technique (n=153) and modified 27-g technique (n=129). The mean age was 71 ±15 years (range 27–92) for group 23-g and 68 ±17 years (range 25–95) for group 27-g. Mean follow-up was 5.6 ±2.7 months (range: 1–24 months).Transient postoperative ocular hypotonia (intraocular pressure ≤5 mmHg) was observed less in the 27-g group (13 vs. four patients, p=0.057) – three requiring additional tunnel sutures (two cases for 23-g; one case 27-g). Postoperative vitreous haemorrhage was recorded more often in the 23-g group (eight vs. one patient, p=0.034), but all cases in both groups resolved without intervention. During the follow-up period of 5.6 ±2.7 months (range: 1–24 months), neither haptic exposure nor scleral or conjunctival erosion was noticed. No complications such as IOL decentration, pupillary capture, pseudo phacodonesis, IOL-tilt, clinical transillumination defect suggestive of chaffing, retinal detachment or endophthalmitis were observed. Visual acuity improved postoperatively in both groups. The mean BCVA increased in the 23-g group from 0.84 ±0.27 LogMAR baseline to 0.4 ±0.28 at the last follow-up (p<0.01). In the 27-g group, the mean BCVA increased from 0.85 ±0.24 LogMAR baseline to 0.3 ±0.31 at the last follow-up (p<0.01). The refractive spherical equivalent at the last follow-up was comparable in the two groups (-0.85 ±0.92D for 23-g and -0.94 ±0.87D for 27-g; p=0.12) The study concluded that the 27-g modified technique for sutureless intrascleral implantation is simple and effective and causes less postoperative hypotony. Limitations: retrospective approach, limited number of patients, short follow-up time, and the bias in the results that may have been caused by the differences in preoperative indications.

Clinical experience of two sutureless intrascleral fixation techniques for secondary intraocular lens implantation.
Januschowskia K, Rickmanna A, Boden K T, et al.
OPHTHALMOLOGICA
2024;247:1–7.