Intraoperative OCT evaluation of the stability and centering of carlevale IOL with different intrascleral fixation techniques

Background: To evaluate intrascleral plug stability and correct centring of the IOL in three different surgical techniques using intraoperative anterior segment OCT.

Methods: This retrospective scientific study was conducted by reviewing patient records from the Ophthalmology Unit at the Civico Hospital of Palermo, covering the period between 2021 and 2022. Three distinct groups of patients, each consisting of 7 eyes from 7 individual patients, were included in this study. The first group received a quadrangular scleral flap (3.5 × 3.5 mm) that covered intrascleral plugs. The second group had two intrascleral pockets created with the insertion of plugs inside these pockets. The third group had one intrascleral pocket created to cover the intrascleral plugs. Intraoperative anterior segment (AS)-OCT was used to monitor the positioning of the plugs and the tilt of the IOL. The analyzed parameters are: best-corrected visual acuity (BCVA), subjective refraction, intraocular pressure (IOP), pachymetry, macular thickness, endothelial cell loss, intraoperative and postoperative complications, IOL tilting, and optic plate decentration.

Results: The examined parameters showed uniformity among the groups. Postoperative best-corrected visual acuity (BCVA), subjective refraction, intraocular pressure (IOP), pachymetry, and macular thickness exhibited no significant differences between the three groups. Endothelial cell loss ranged between 10.4% and 13.1% across the patient groups. No intraoperative or postoperative complications were reported. No IOL tilting or optic plate decentration was reported. The duration of surgeries was similar among the groups.

Conclusions: The three different scleral fixation techniques have been shown to be equally effective, demonstrating the usefulness of intraoperative AS-OCT for the stability and centring of Carlevale IOLs.