A novel approach for scleral fixation using Carlevale lens.

Purpose: To evaluate the surgical outcomes and feasibility of a novel approach for scleral-fixation using a single-piece acrylic foldable Carlevale lens (Soleko).

Methods: Eighteen eyes of 18 patients with aphakia, dislocated IOL, subluxated lens, anisometropia, perforated trauma, and retinal detachment who underwent IOL implantation with a Carlevale lens were evaluated. All the patients underwent a standard ophthalmologic examination. Anterior segment (AS)-OCT was used postoperatively to check plugs positioning and IOL tilt.

Results: Mean patients age was 73 ± 19 years. Mean follow-up was 11.2 ± 4.1 months. Mean axial length was 23.7 ± 1.65 mm, white-to-white distance was 11.74 ± 0.40 mm, and axial length was 23.67 ± 1.65 mm. Refractive spherical equivalent prediction error was -0.31 ± 0.71D. Mean IOL tilt was 2.2° ± 1.6° and plugs were placed within the sclera. Five patients had aphakia, five in-the-bag IOL subluxation, three in-the-bag IOL luxation, one high residual myopia after previous verisyse implant, one Uveitis-Glaucoma-Hyphema syndrome, one perforating trauma with phacodonesis, one intraocular foreign body and retinal detachment, two lens subluxation. One eye developed cystoid macular edema which disappeared with topical steroids and FANS. No other complications were observed throughout the follow-up.

Conclusion: Carlevale lens (Soleko) appears to be a viable option for both anterior and posterior segment surgeons in the management of complex cases providing less challenging maneuvers which lead to a good lens self-centration and minimal risk of haptic rupture and/or dislocation. The lens seems to offer a good compartmentalization between the anterior and posterior chamber reducing the risk of an inflammatory response.