A Retrospective Review Of 172 Cases Using Intrascleral Transtrocar Sutureless Subconjunctival Fixation Of Carlevale Hydrophilic Implant

This study evaluates the outcomes of employing the 25 gauge intrascleral transtrocar sutureless subconjunctival fixation technique for Carlevale  implantation. Through a retrospective analysis of 172 cases over 4 years ( January 2020 to December 2023), we aim to assess the technique's safety, efficacy, and incidence of adverse effects.

Conducted at ‘Ophthalmos Research and Educational Institute’, Nicosia, Cyprus. Carlevale  implantation was performed for aphakia, intraocular implant dislocation or phacodonesis , and following complicated cataract surgery or ocular trauma with no capsular support.

This study harnesses a seminal approach to scleral-fixated IOL implantation, using a less invasive procedure that avoids scleral flaps and conjunctival peritomy. The 25g vitrectomy trochars are placed at 0 and 180 degrees and 2mm from limbus for optimised positioning of the lens fixation, and the lens T-haptics are externalised between the conjunctiva and sclera, without the use of sutures or flaps.

Our analysis encompasses 172 patients treated with the Carlevale implant using the specified technique. We meticulously recorded refractive results and BCVA, which was divided into Group 1: 41.2% for VA 6/6 to 6/9, Group 2: 50.8% for VA 6/12 to 6/60 and Group 3: 7.8% for VA 6/120 or worse. Adverse effects were also documented, such as short-term cystoid macular edema (9 x cases, 5.2%), corneal decompensation requiring DSAEK ( 9 x cases, 5.2%), transient IOP increase (7 x cases, 4.06%), hyphema (7 x cases ,4.06%), vitreous hemorrhage (6 x cases, 3.4%), retinal detachment (3 x cases, 1.7%), hypotony and plug externalisation (2 x cases,1.1%), anterior chamber inflammatory reaction (1 x case, 0.5%), and lens malpositioning (1 case, 0.5%).

The intrascleral 25g transtrocar sutureless subconjunctival fixation of the Carlevale implant represents an innovative technique that preserves the ocular tissues, reduces suture-related complications, surgery time and complexity. This technique offers a revolutionary approach to complex lens implantation cases, marked by a commendable safety profile and effective outcomes. Its adoption signifies a pivotal shift towards minimally invasive, yet highly effective surgical solutions, promising enhanced patient outcomes and a valuable alternative when capsular support is compromised or absent.