Abstract
Purpose :
The Zeiss CT Lucia 602 intraocular lens (IOL) is often used on an off-label basis for the Yamane technique, a method for scleral fixation in which the IOL haptics are embedded in the sclera. Multiple surgeons within our institution have recently found acute onset severe tilt in previously well-positioned IOLs fixated in this manner. The goal of this study is to better characterize these cases compared with routine cases to identify contributory factors.
Methods :
Secondary IOL cases at our academic center from 7/1/22 to 12/16/22 were identified using the electronic medical record. Of 57 total cases, 46 involved scleral fixation of a CT lucia IOL using the Yamane technique. Cases were identified in which the surgeon documented perioperative tilting of the IOL. Intraoperative factors (IOL power, surgeon, surgical approach), ocular anatomy (axial length, white-to-white, indication for surgery, prior surgery), and visual outcome (visual acuity, refraction) were also reviewed.
Results :
There were five cases of severe tilt requiring IOL removal. Two cases of mild tilt were identified for which the patients are being monitored. Cylinder magnitude correlated with tilt classification (+3.75 D for severe tilt, +1.50 for mild tilt, and +1.07 for no tilt). In all cases of severe tilt, the initial IOL position was acceptable, with spontaneous tilt arising in the first 3 post-operative weeks. In one case both haptics became detached from the optic during subsequent IOL explantation. The procedures were performed by four different surgeons including attending physicians and trainees. No clear pattern in surgical technique or ocular anatomy was evident in these cases compared with controls. All cases of severe tilt occurred with lens power +17.0 to +18.5 D (vs +8.0 to +24.5 D for all cases). This corresponded to severe tilt in 50% (n=10) of IOLs in this diopter range, vs 0% severe tilt and 6% mild tilt (n = 36) outside this range.
Conclusions :
We describe a case series of scleral-fixated CT lucia 602 IOLs that underwent severe tilt perioperatively. While post-operative tilt and decentration can occur with scleral-fixated and sutured IOLs, the degree of tilt and rapid, spontaneous change from well-positioned to tilted was anomalous. The correlation of lens power with incidence of severe tilt may reflect a manufacturing issue involving the haptic/optic junction.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.