Endoscope-Assisted Carlevale Lens Implantation in Patients Without Capsular Support: A Novel Surgical Approach to Ensure Correct Lens Positioning

Abstract

Purpose: To describe endoscope-assisted Carlevale intraocular lens (IOL) implantation. Methods: Twelve eyes underwent posterior vitrectomy combined with Carlevale IOL implantation and endoscopy in a single procedure, using a technique developed by the authors. Transscleral incisions were performed under direct visualization of the sulcus using the endoscope, and the final lens position was checked at the end of each intervention. The main outcome was to determine the exact position of all lens fixation points.Results: All plugs were correctly placed in the sulcus, but in seven eyes (58.3%), at least one of the closed-loop haptics was folded over the ciliary body. Repositioning was performed during the same procedure. Given that each IOL has four closed-loop haptics, the incidence of this complication was 23% (11/48).Conclusion: Blind implantation of Carlevale IOL may cause a high incidence of haptic malpositioning. Because the sulcus and the ciliary body are not visible under the microscope, endoscopy is the only way to ensure correct lens implantation. This new technique ensures that all lens fixation points are correctly placed by the end of surgery, avoiding complications such as decentration or tilting of the IOL, damage to the iris or the ciliary body, and uveitis.

Scleral Fixation of Carlevale Intraocular Lens: A Systematic Review And Meta-Analysis

“…The mean change in BCVA, which was reported in 13 studies with a total of 550 eyes, is presented in Figure 2A. 7,8,10–17,20,21,23 The pooled results showed a significant improvement in BCVA in patients who underwent SSF with Carlevale IOL (WMD = 0.38, 95% CI: 0.30–0.46, P <0.001; heterogeneity [I 2 ] =52.02%). Funnel plot and Egger regression revealed no publication bias with an Egger coefficient of −0.88 (95% CI: −2.55–0.77, Prob > |t| = 0.25) (see Figures 1 and 2 , Supplemental Digital Content 3 , http://links.lww.com/IAE/C19).…”

“…7–23 Notably, 13 studies were included in the meta-analysis of the mean change in BCVA, 7,8,10–17,20,21,23 four studies in the meta-analysis of the mean change in IOP 10,11,13,16 and ECD, 11,12,15,23 and 16 studies were included in the meta-analysis of the incidence rate of postoperative complications. 7–18,20–23…”

“…We assessed three retrospective observational comparative studies 9,18,22 and 14 case series studies. 7,8,10–17,19–21,23 Among the observational comparative studies, two studies 9,22 compared two different SSF techniques using either the three-piece IOL or the iris claw lens and the Carlevale IOL and only one compared the surgical outcomes of two different scleral fixation techniques using only the Carlevale IOL. 18…”

“…Moreover, Veronese et al 10 described a different surgical technique in which the transscleral plug was intentionally left beneath the conjunctiva. Finally, Dyrda et al 8 introduced a new endoscope-guided surgical technique to ensure that all lens fixation points were correctly placed by the end of surgery to reduce IOL malpositioning that could result in severe complications.…”

“…The IOL is designed to be suspended in the posterior chamber through two transscleral plugs, and its implantation results in excellent lens stability. 7–23…”