Severe Spontaneous Tilt of Scleral-Fixated Intraocular Lenses

• Published in: American journal of ophthalmology Vol. 262; pp. 206 - 212
• Main Authors: Enright, Jennifer M., Purt, Boonkit, Bruck, Brent, Shah, Parth, Eton, Emily, Rezaei, Sina, Armenti, Stephen, Patel, Kishan G., Liu, James, Verkade, Angela, Hamad, Abdualrahman, Wubben, Thomas J., Sheybani, Arsham, Crandall, David, Tannen, Bradford L., Comer, Grant M., Mian, Shahzad, Nallasamy, Nambi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2024
• Subjects: Aged; Aged, 80 and over; Artificial Lens Implant Migration - physiopathology; Artificial Lens Implant Migration - surgery; Cross-Sectional Studies; Female; Humans; Lens Implantation, Intraocular - methods; Lenses, Intraocular; Male; Middle Aged; Phacoemulsification; Sclera - surgery; Visual Acuity - physiology
• ISSN: 0002-9394; 1879-1891; 1879-1891
• DOI: 10.1016/j.ajo.2024.02.006

To report and evaluate a multicenter series of 18 cases of severe, spontaneous IOL tilt involving the flanged intrascleral haptic fixation technique (FISHF).
Clinical study with historical controls.
We report a cross-sectional study of 46 FISHF cases using the CT Lucia 602 IOL at a single academic center over a period of 24 weeks to determine the incidence of severe rotisserie-style rotational tilt. These rates were then compared with the same time-frame the prior year to help determine if this is a new phenomenon. Additional cases of severe tilt were solicited from another 4 academic centers.
Among 46 FISHF cases at a single center, 5 developed severe tilt. No clear pattern in surgical technique, ocular history, or ocular anatomy was evident in these cases compared with controls, although the involved IOLs clustered within a narrow diopter range, indicative of a batch effect. In the same 24-week interval the year before, 33 FISHF cases were performed, none of which exhibited severe rotational tilt. In our multicenter dataset, 18 cases of tilt were identified. Surgeons included fellow and early-career physicians as well as surgeons with multiple years of experience with the Yamane technique. A variety of surgical approaches for FISHF were represented. In at least 8 of the cases, haptic rotation and/or dehiscence at the optic-haptic junction were documented.
The identification of haptic rotation and dehiscence intraoperatively in several cases may reflect a new stability issue involving the optic-haptic junction.