Introduction: The aim of this study was to evaluate the outcome of the modified Carlevale intraocular lens (IOL) fixation technique, using two different vitrectomy ports (23- vs. 27-gauge) as anchor fixation. Methods: Retrospective, consecutive study of 282 eyes (282 patients) who underwent a secondary IOL implantation using the Carlevale IOL (Soleko IOL Division, Italy) with two anchor haptics for intrascleral implantation with either 23- or 27-gauge (G) port. Results: Transient post-operative ocular hypotonia (intraocular pressure ≤5 mm Hg) was observed less in the 27-G group (13 vs. 4 patients, p = 0.057) three requiring additional tunnel sutures (2 cases for 23-G; 1 case 27-G). Post-operative vitreous haemorrhage was recorded more often in the 23-G group (8 vs. 1 patient, p = 0.034), but all cases in both groups resolved without intervention. Visual acuity did improve post-operatively in the two groups. No post-operative complications such as retinal detachment, endophthalmitis, and IOL-dislocation tilt were observed in the follow-up. Conclusion: The 27-G modified technique for sutureless intrascleral implantation is simple and effective and causes less post-operative hypotony.

Ascaso FJ, Huerva V, Grzybowski A. Epidemiology, etiology, and prevention of late IOL-capsular bag complex dislocation: review of the literature. J Ophthalmol. 2015;2015:805706.
Por YM, Lavin MJ. Techniques of intraocular lens suspension in the absence of capsular/zonular support. Surv Ophthalmol. 2005;50(5):429–62.
Wagoner MD, Cox TA, Ariyasu RG, Jacobs DS, Karp CL; American Academy of Ophthalmology. Intraocular lens implantation in the absence of capsular support: a report by the American Academy of Ophthalmology. Ophthalmology. 2003;110(4):840–59.
McCluskey P, Harrisberg B. Long-term results using scleral-fixated posterior chamber intraocular lenses. J Cataract Refract Surg. 1994;20(1):34–9.
McAllister AS, Hirst LW. Visual outcomes and complications of scleral-fixated posterior chamber intraocular lenses. J Cataract Refract Surg. 2011;37(7):1263–9.
Uthoff D, Teichmann KD. Secondary implantation of scleral-fixated intraocular lenses. J Cataract Refract Surg. 1998;24(7):945–50.
Vote BJ, Tranos P, Bunce C, Charteris DG, Da Cruz L. Long-term outcome of combined pars plana vitrectomy and scleral fixated sutured posterior chamber intraocular lens implantation. Am J Ophthalmol. 2006;141(2):308–12.
Cahane M, Chen V, Avni I. Dislocation of a scleral-fixated, posterior chamber intraocular lens after fixation suture removal. J Cataract Refract Surg. 1994;20(2):186–7.
Szurman P, Petermeier K, Aisenbrey S, Spitzer MS, Jaissle GB. Z-suture: a new knotless technique for transscleral suture fixation of intraocular implants. Br J Ophthalmol. 2010;94(2):167–9.
Dimopoulos S, Dimopoulos V, Blumenstock G, Trevino-Rodriguez H, Bartz-Schmidt KU, Spitzer MS, et al. Long-term outcome of scleral-fixated posterior chamber intraocular lens implantation with the knotless Z-suture technique. J Cataract Refract Surg. 2018;44(2):182–5.
Yamane S, Sato S, Maruyama-Inoue M, Kadonosono K. Flanged intrascleral intraocular lens fixation with double-needle technique. Ophthalmology. 2017;124(8):1136–42.
Holt DG, Young J, Stagg B, Ambati BK. Anterior chamber intraocular lens, sutured posterior chamber intraocular lens, or glued intraocular lens: where do we stand?Curr Opin Ophthalmol. 2012;23(1):62–7.
Veronese C, Maiolo C, Armstrong GW, Primavera L, Torrazza C, Della Mora L, et al. New surgical approach for sutureless scleral fixation. Eur J Ophthalmol. 2020;30(3):612–5.
Barca F, Caporossi T, de Angelis L, Giansanti F, Savastano A, Di Leo L, et al. Trans-scleral plugs fixated IOL: a new paradigm for sutureless scleral fixation. J Cataract Refract Surg. 2020;46(5):716–20.
Januschowski K, Boden KT, Macek AM, Szurman P, Bisorca-Gassendorf L, Hoogmartens C, et al. A modified sutureless intrascleral fixation technique for secondary intraocular lens implantation: a pilot study. Retina. 2021. Publish Ahead of Print.
Pfister RR. The intraocular changes of anterior segment necrosis. Eye. 1991;5(Pt 2):214–21.
Enghelberg M, Chalam KV. Ultra wide field angiography documented peripheral retinal eovascularization as cause of vitreous hemorrhage after scleral buckle surgery. J Surg Case Rep. 2020;2020(6):rjaa142.
Anastasilakis K, Mourgela A, Kaniouras D, Moschou K. Tips, tricks, and advantages of 27-G vitrectomy. Ophthalmologica. 2018;239(2–3):176–7.
Naruse S, Shimada H, Mori R. 27-gauge and 25-gauge vitrectomy day surgery for idiopathic epiretinal membrane. BMC Ophthalmol. 2017;17(1):188.
Gabai A, Zeppieri M, Toneatto G, Salati C. Enhanced surgical technique for sutureless intrascleral fixation of intraocular lenses. J Cataract Refract Surg. 2021;47(12):e75–9.
Rossi T, Iannetta D, Romano V, Carlevale C, Forlini M, Telani S, et al. A novel intraocular lens designed for sutureless scleral fixation: surgical series. Graefes Arch Clin Exp Ophthalmol. 2021;259(1):257–62.
You do not currently have access to this content.