Severe Rotisserie Tilt of Scleral-Fixated CT Lucia 602 Intraocular Lenses: A Multicenter Case Series

This multicenter case series describes severe rotisserie tilt of scleral-fixed CT Lucia 602 intraocular lenses (IOL) observed across multiple surgeons and centers between 2021 to 2023. The study reviewed 1,408 intrascleral haptic fixation (ISHF) surgeries performed by 20 surgeons from 18 centers, including both retina and anterior segment specialists, at both academic and private practice settings, and identified 45 tilted IOL cases with the CT Lucia requiring surgical intervention. There was a wide variation in instrumentation, tunnel construction approaches, and lens insertion techniques. The average estimated tilt was 74.8º ± 40.1º. Abnormalities in the haptic-optic junction were found in 34 of 45 (76%) cases. Management included replacing the IOL, placing an anterior chamber IOL, refixating the IOL, or leaving the patient aphakic. Of those receiving another CT Lucia lens, seven of 16 (44%) cases experienced repeat tilt, representing a meaningful risk of recurrence. Given the heterogeneity of surgeon technique, our findings may represent a concerning reproducible failure phenotype.