Visual And Refractive Outcomes Following Combined Ultra-Thin Descemet Stripping Automated Endothelial Keratoplasty And Sutureless Scleral Fixation Of The Carlevale Iol

To evaluate visual, refractive, and corneal outcomes of combined ultra-thin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and sutureless scleral fixation of the Carlevale intraocular lens (SSF-Carlevale IOL) in aphakic patients with corneal endothelial decompensation.

Our single center retrospective study was conducted at the Eye Clinic of Misericordia Hospital of Grosseto (Italy) and included a total of 8 eyes from 8 patients affected by bullous kerathopathy (BK) and cataract who underwent combined UT-DSAEK and SSF-carlevale IOL implantation in a single procedure, performed by the same surgeon (A.B.).

Preoperative evaluation included Scheimpflug-Placido tomography (Sirius, CSO, Italy) and optical biometry (IOLMaster 700, Carl Zeiss Meditec). IOL power was calculated using the SRK/T formula.

Patients were examined at 6 and 12 months postoperatively. The following parameters were analyzed: uncorrected and corrected distance visual acuity (UDVA, CDVA), spherical equivalent (SE), intraocular pressure (IOP), endothelial cell density (ECD), central corneal thickness (CCT), graft thickness (GT), and corneal higher-order aberrations (HOAs).

Graft clarity was maintained in 88% of eyes during follow-up. One case required repeat endothelial keratoplasty due to graft rejection.

Both UDVA and CDVA improved significantly compared with baseline (p < 0.001).Refractive outcomes were stable and predictable, with a consistent spherical equivalent at 12 months. Endothelial cell density decreased from donor baseline values at 12 months, consistent with expected postoperative endothelial cell loss. Central corneal thickness and graft thickness showed progressive reduction over time, indicating graft stabilization. Total higher-order aberrations were significantly reduced.No major intraoperative or postoperative complications, confirming the favorable safety profile of the combined procedure.

Combined UT-DSAEK and sutureless scleral fixation of the Carlevale IOL appears to be a safe and effective surgical strategy.The procedure was associated with high graft survival,significant visual improvement, and predictable refractive outcomes, supporting its reliability when endothelial keratoplasty and secondary IOL implantation are required in the same surgical setting.

However, the present study is limited by its retrospective design and small sample size. Larger, prospective and comparative studies with extended follow-up are necessary to confirm the reproducibility and long-term stability of these outcomes.