ESCRS - FP03.14 - Six-Year Clinical Outcomes Of Flapless 25-Gauge Transtrocar Subconjunctival Carlevale Iol Fixation In 268 Eyes

Six-Year Clinical Outcomes Of Flapless 25-Gauge Transtrocar Subconjunctival Carlevale Iol Fixation In 268 Eyes

Published 2026 - 44th Congress of the ESCRS

Reference: FP03.14 | Type: Free paper | DOI: 10.82333/bzph-s587

Authors: Dr Vasiliki Mamareli* 1 , Mrs Anastasia Neokleous 1 , Mr Panayiotis Neophytou 1 , Mrs Cristina Ikonomu 1 , A/Prof. Tassos Georgiou 1

1Ophthalmology,Ophthalmos Research and Educational Institute,Nicosia,Cyprus

Purpose

To evaluate long-term visual, refractive, and safety outcomes of a flapless, sutureless 25-gauge transtrocar intrascleral subconjunctival fixation technique for Carlevale intraocular lens (IOL) implantation in eyes lacking capsular support.

Setting

Ophthalmos Research and Educational Institute, Nicosia, Cyprus.

Methods

This retrospective consecutive case series included 268 eyes that underwent Carlevale IOL implantation between January 2020 and December 2025. Indications included aphakia, dislocated IOL, zonular insufficiency, and absence of capsular support following complicated cataract surgery or ocular trauma.

A minimally invasive sutureless, flapless technique used two 25-gauge trocars placed 180° apart, 2 mm from the limbus. T-shaped haptics were externalised through the trocars and secured intrasclerally under the conjunctiva, achieving stable fixation without scleral flaps and sutures.

Primary outcomes included postoperative best-corrected visual acuity (BCVA), spherical equivalent (SE), refractive predictability, and postoperative complications.

Results

At six years, 131 eyes (48.9%) achieved BCVA ≥6/12, reflecting the complex baseline pathology typical of eyes without capsular support.

Refractive predictability was high and improved over time. In the 2020–2023 cohort, 50% of eyes were within ±0.50 D and 80% within ±1.00 D of target spherical equivalent. In the 2024–2025 subgroup, 90.6% of eyes (87/96) were within ±1.00 D.

Complication rates were low and manageable:

  • Cystoid macular edema: 5.6%
  • Corneal decompensation requiring endothelial keratoplasty: 5.2%
  • Transient IOP elevation: 3.4%
  • T-haptic plug exposure: 3.4%
  • Hyphema: 2.6%
  • Vitreous hemorrhage: 2.2%
  • Retinal detachment: 1.5%
  • Lens tilt/malposition: 0.7%
  • Anterior chamber inflammation: 0.7%

No cases of endophthalmitis were observed.

Conclusions

Flapless 25-gauge transtrocar subconjunctival fixation of the Carlevale IOL provides a stable, predictable, and minimally invasive solution for eyes without capsular support. The technique eliminates the need for scleral flaps or sutures while maintaining good refractive accuracy and a favorable long-term safety profile over six years.