Infusion misdirection syndrome: preventive and management strategies.

is simpler and might result in less intraoperative complications with a better stability of the IOL–capsular bag complex. Recently, we have adopted the newly released Carlevale IOL (FIL-SSF) in most cases of scleral fixation with or without capsular bag instability. This specific foldable IOL can be inserted through a 2.2 mm corneal tunnel and is easily fixated to the sclera with excellent centration. The Carlevale IOL is a hydrophilic acrylic IOL with 4 points of scleral sulcus counterpressure and T-shaped harpoons protruding off the closed haptics to allow self-anchoring on the sclera without the need for sutures. This IOL is 13.2mm long, and the optic plate is 6.5mmwide. Our surgical series with Carlevale IOL consists of 18 patients. Indications for surgery were IOL dislocation (12 cases [67%]), IOL exchange due to IOL opacification (5 cases [28%]), and secondary implant due to complicated cataract surgery (1 case [5%]). The mean ± SD age of patients was 81.3 ± 4.1 years. The mean preoperative corrected distance visual acuity was 0.69 ± 0.51 logarithm of the minimum angle of resolution (logMAR). After a mean follow-up of 9.3 ± 6.9 months, the mean corrected distance visual acuity improved by 2.6 Early Treatment Diabetic Retinopathy Study lines to 0.43 ± 0.48 logMAR (P = .001). We recorded 1 case (5.5%) of transient intraoperative bleeding in the anterior chamber. An optimal centration and stability of the IOL were observed in all cases. No cases of scleral or conjunctival erosion were observed. One case (5.5%) of transient intraocular pressure increase developed postoperatively. We believe that new developments in surgical techniques and IOL design offer the ophthalmic surgeon a plethora of options, allowing safe and stable lens positioning in the absence of viable capsule remnants even in more complicated cases.—Daniele Veritti, MD, Lisa Grego, MD, Francesco Samassa, MD, Valentina Sarao, MD, Paolo Lanzetta, MD