Prospective Comparative Study (Ssis Pi-20-074) Of Scleral-Fixated Three-Piece Versus Carlevale® Secondary Iol Implantation In Eyes Without Capsular Support
Published 2026 - 44th Congress of the ESCRS
Reference: FP24.13 | Type: Free paper | DOI: 10.82333/mfmm-3z26
Authors: Mr Kevin Andrés Castaño Castillo* 1 , Dr José Ramón Anglada Escalona 1 , Mr Jordi Castellví Manent 1 , Ms Anna Goñi Guarro 1
1Opthalmology,Hospital Germans Trias i Pujol,Barcelona,Spain
Purpose
To compare visual outcomes, surgically induced astigmatism (SIA), endothelial cell density (ECD) loss, and postoperative complications between scleral-fixated three-piece intraocular lenses (3p) and Carlevale® secondary intraocular lenses in eyes without capsular support following cataract surgery.
Setting
Prospective four-year clinical study conducted in a tertiary referral university hospital managing complex anterior and posterior segment cases.
Methods
Prospective comparative study including 198 eyes undergoing secondary intraocular lens implantation associated with 23-gauge pars plana vitrectomy. Eyes were divided into scleral-fixated three-piece intraocular lenses (3p, n=102) and Carlevale® lenses (C, n=96). Best-corrected visual acuity (BCVA), SIA, ECD loss, and postoperative complications were analyzed. Statistical analysis was performed according to data distribution using appropriate parametric or non-parametric tests.
Results
Final BCVA (decimal scale) was comparable between groups:
3p: 0.74 ± 0.27; C: 0.68 ± 0.24 (p=0.905).
Surgically induced astigmatism (diopters) showed no significant differences:
3p: 0.73 ± 0.54 D; C: 0.76 ± 0.45 D (p=0.597).
Mean endothelial cell loss was 9.24 ± 12.77% (3p) and 13.43 ± 17.23% (C) (p=0.603).
Refixation of an existing three-piece lens without anterior chamber passage resulted in significantly lower endothelial loss (3.95 ± 7.81%) compared with 3p explantation (p=0.002) and C (p=0.001).
Haptic subluxation occurred in 1 eye (1.79%) in 3p and none in C.
Macular edema developed in 2 eyes (2.63%) in 3p and 6 eyes (10.3%) in C. One retinal detachment (3.2%) occurred in C.
Conclusions
Both scleral-fixated three-piece and Carlevale® techniques provided comparable visual and refractive outcomes in eyes without capsular support.
Overall endothelial cell loss did not differ significantly between groups.
Refixation of an existing three-piece lens significantly reduced endothelial damage by avoiding anterior chamber manipulation.
Carlevale® implantation showed a higher incidence of postoperative macular edema.
Technique selection should be individualized according to ocular characteristics and surgical considerations.