Comparison of Carlevale and Artisan retropupillary iris-claw intraocular lens fixation for managing aphakia: a systematic review and meta-analysis

PURPOSE: Carlevale and retropupillary iris-claw Artisan intra-ocular lenses (IOLs) treat aphakia without capsular support, but their relative performance is uncertain. METHODS: PubMed, Embase and the Cochrane Library were searched to March 2025. PRIMARY OUTCOMES: best-corrected visual acuity (BCVA), surgically induced astigmatism (SIA), mean absolute refractive error (MARE) and mean refractive error (MRE). SECONDARY OUTCOMES: operating time and postoperative complications. Random-effects meta-analysis with I² and incision-type subgroups was performed. RESULTS: Five studies comprising 631 eyes (229 Carlevale, 402 iris-claw) met inclusion criteria. Mean age was 70.1 ± 14.1 years, 61.18% were male; follow-up ranged from 1.3 to 11.5 months. BCVA did not differ between groups (- 0.01 logMAR; 95% CI - 0.13 - 0.11; p = 0.91; I²=43%). Carlevale reduced SIA (- 0.53D; 95% CI - 1.03 to - 0.04; p = 0.03; I²=73.7%), however, the benefit was confined to corneal-incision iris-claw comparators, not scleral-incision. MARE showed no overall difference, yet corneal-incision iris-claw cases were less predictable (MD-0.32; 95% Cl: -0.62-0.19, p = 0.30, I² =81.7%). Carlevale produced a myopic shift relative to iris-claw (- 0.66D; 95% CI - 0.87 to - 0.46; p < 0.01; I²=31.3%). Carlevale procedures were 11.9 min longer (95% CI 5.2-18.6; p < 0.01; I²=80.2%). Complication rates were comparable overall except for fewer IOL dislocations with Carlevale (OR 0.16; 95% CI 0.03-0.87; p = 0.034; I²=0%). CONCLUSIONS: Both lenses provide similar visual acuity and safety in aphakic eyes lacking capsular support. Carlevale confers lower dislocation risk and greater refractive predictability relative to corneal-incision iris-claw implantation, at the expense of a longer operating time. Incision-related heterogeneity highlights the need for standardised surgical and reporting frameworks.