Iol Implantation In Absence Of Capsular Support, Comparison Between Two Different Techniques Of Sutureless Scleral Fixated Iol (Carlevale Vs Yamane): Visual Outcome, Complications And As-Oct Analysis

To compare the visual outcome, intraoperative and postoperative complications of the foldable one piece sutureless scleral fixated intraocular lens (Carlevale IOL) versus the scleral fixated sutureless three-piece IOL (Yamane technique). Additionally, within a patients' subgroup, we evaluate the IOL tilt and decentration of these sutureless scleral-fixated IOLs using second generation swept-source anterior segment OCT (AS-OCT)

Single-surgeon, monocentric, retrospective study in the Ophthalmology Department of Beauregard Hospital, Azienda USL della Valle d’Aosta, Italy. 

We reviewed consecutive patients undergoing Carlevale IOL implantation or Yamane technique implantation between January 2021 and June 2024. At six months postoperatively, second generation swept-source AS-OCT imaging was performed to quantify IOL tilt and decentration with a semi-automatic software. Statistical analysis was applied to compare the stability and safety profiles of both technique. 

A total of 101 eyes from 100 patients were included: 32 in the Carlevale group and 69 in the Yamane group. Complication rates at 1, 3, 6, and 12 months were comparable between the two groups. However, on postoperative day one, the Yamane group exhibited a significantly higher incidence of self-limiting anterior chamber hyphaema, all of which resolved spontaneously within one week.

As regards the tilt and decentration, a total of 33 eyes were evaluated with AS-OCT (19 eyes in the Yamane group; 14 eyes in the Carlevale group). The mean tilting and mean decentration in the Yamane group were respectively 6.9° and 0.61 mm, compared to 6.4° and 0.48 mm in the Carlevale group (p=0.59; p=0,23). Mean BCVA improved significantly in both groups.

Both surgical techniques demonstrate a high safety profile and functional outcomes, provided standardised surgical protocols are strictly followed. Postoperative complications were similar across both groups. The AS-OCT analysis revealed no statistically significant differences in IOL tilt and decentration between the two techniques. However, a trend toward lower decentration was observed with the Carlevale IOL compared to the Yamane technique. Overall, in this sample, the mean values for tilting and decentration obtained with AS-OCT were clinically acceptable and low in magnitude, reaffirming the high precision and reliability of these sutureless approaches.