Hybrid approach integrating classical scleral pocket and Hoffman pocket for Carlevale IOL scleral fixation in a patient with dislocated lens and severe conjunctival scarring

We introduce a hybrid surgical approach for Carlevale intraocular lens (IOL) fixation, combining scleral and Hoffman pocket techniques to address preoperative conjunctival scarring in a patient with IOL dislocation requiring exchange. The dislocated IOL was removed, and a Carlevale IOL was implanted with a classical scleral fixation nasally and the Hoffman technique temporally due to conjunctival scarring from previous strabismus surgery. During follow-up, the Carlevale IOL remained stable and visual acuity improved significantly. This hybrid approach, integrating Hoffman pocket without conjunctival dissection, is a viable alternative when conjunctival scarring is present, expanding the surgical options for Carlevale IOL fixation.