Sutureless Scleral Fixation of the Carlevale IOL: A 5-Year Retrospective Study

Purpose: To report the surgical and refractive outcomes over a 5-year follow-up period in patients who underwent sutureless scleral fixation of a one-piece intraocular lens (IOL). Methods: A retrospective study was conducted at one single center involving consecutive patients undergoing sutureless scleral fixation of one-piece IOL implantation, between September 2016 and May 2020. Visual acuity, refractive outcomes, and complications were assessed over a minimum 60-month follow-up period. Results: The study included 28 eyes of 28 patients (7 women and 21 men; mean age 61.0 ± 19.4 years [95% CI: 53.4 to 68.5]). Five years after surgery, mean corrected distance visual acuity significantly improved from 1.1 ± 0.6 logarithm of the minimum angle of resolution (95% CI: 0.9 to 1.3) to 0.5 ± 0.6 (95% CI: 0.3 to 0.8 logarithm of the minimum angle of resolution) ( P < .001) with a mean refractive prediction error of −0.04 ± 1.30 diopters (95% CI: −0.53 to +0.45 diopters). After surgery mean endothelial cell count significantly decreased from 2,037 ± 455 cells/mm 2 (95% CI: 1,861 to 2,213 cells/mm 2 ) to 1,704 ± 483 cells/mm 2 (95% CI: 1,517 to 1,891 cells/mm 2 ) ( P < .001), with a mean loss of 16.9%. A mean IOL tilting of 2.7 ± 0.9 degrees (95% CI: 2.3 to 3 degrees) was found at 60 months postoperatively. The most common postoperative complication were corneal edema in the early course (2 eyes, 7.2%) and localized scleral thinning over the haptic in the late course (9 eyes, 32.1%). At 5 years postoperatively, anterior segment optical coherence tomography showed preserved scleral thickness 199.3 ± 72.7 μm (95% CI: 172.4 to 226.2 μm). Conclusions: Sutureless intrascleral fixation of the one-piece IOL demonstrated satisfactory long-term outcomes with good visual acuity and a low rate of complications.