A mini-invasive surgical technique for Carlevale IOL implantation: case series study and description of concomitant surgery

Abstract

Purpose To examine the feasibility and outcomes of a modified technique for the implantation of scleral fixated Carlevale intraocular lens (IOL) (I71 FIL SSF. Soleko IOL Division, Pontecorvo, Italy), and to analyze the occurrence of adverse events. Methods This is a retrospective observational study conducted revising patients charts from 2018 to 2023. Thirty-five eyes of 33 patients were included. Patients requiring IOL explantation had either IOL dislocation or opacification. The implantation of the Carlevale IOL was performed with the subconjunctival positioning of the anchors without any scleral flap. All maneuvers were performed transconjunctivally. The anatomical outcomes considered were IOL positioning, and the absence of postoperative complications. The functional outcomes analyzed were best correctedvisual acuity (BCVA) and refraction. Results In all the cases, the IOL was well positioned and centered postoperatively. No cases of conjunctival erosion were recorded. The best corrected visual acuity (BCVA) was 0.9±0.6 logMar (mean±standard deviation) preoperatively and 0.5±0.5 logMar (mean±standard deviation) postoperatively. The mean preoperative spherical equivalent was +6.8±7.7 dioptres, while postoperatively it was -1.1±1.6 dioptres. The most frequent procedure associated to secondary IOL implantation was posterior vitrectomy (25 eyes, 71.4%), which was performed with 25-gauge transconjunctival cannulas in the ciliary sulcus. The follow-up period was 24.5±16.9 months (mean±standard deviation). Conclusion The described mini-invasive technique for Carlevale IOL implantation is safe and effective. It can be recommended either as a stand-alone operation or associated to concurrent surgical procedures.

Current Evidence for a New Surgical Technique for Scleral Fixation: The Implantation of a Carlevale Lens, a Systematic Review

“…All the authors reported an improvement in the best corrected visual acuity (BCVA) [ 1 , 20 , 21 , 22 , 24 , 25 , 30 , 32 , 34 , 38 , 44 , 45 ] ( Table 1 ), and in comparison to the Artisan iris claw lens (Artisan Aphakia IOL model 205, Ophtec BV, Gro-ningen, The Netherlands), no significant difference ( p = 0.19) was highlighted [ 26 , 29 , 36 ]. Some authors did not consider the refractive and/or visual outcomes [ 27 , 28 , 38 , 43 ] while other authors reported only post-operative visual data [ 8 , 9 , 26 , 40 ].…”

“…Regarding corneal astigmatism ( Table 3 ), some authors did not show any changes from the pre-operative to the postoperative time [ 21 , 28 , 36 , 44 ]. Mularoni and colleagues [ 32 ] reported a small increase between pre-operative and post-operative astigmatisms.…”