Horizontal Scleral Incisions for Fixation of Carlevale Intraocular Lens: A Useful Surgical Variant

PURPOSE: To describe a surgical technique based on the creation of horizontal scleral incisions for sutureless fixation of the Carlevale intraocular lens (IOL) (I71 FIL SSF. Soleko IOL Division, Pontecorvo, Italy) in eyes without adequate capsular support. METHODS: This retrospective interventional case series included eyes undergoing secondary IOL implantation using a Carlevale IOL. The technique consisted of creating two opposite horizontal scleral incisions, aligned with the haptic orientation, allowing stable intrascleral fixation of the T-shaped plugs without sutures or scleral flaps. Functional and anatomical outcomes were evaluated over a 3-month follow-up. RESULTS: Twelve eyes were included. Mean best-corrected visual acuity (BCVA) improved from 0.48 ± 0.21 logMAR preoperatively to 0.34 ± 0.18 logMAR at 3 months (p = 0.029). All IOLs remained well centered and stable. No cases of IOL dislocation or endophthalmitis were observed. One eye developed transient hypotony that resolved spontaneously. CONCLUSIONS: Horizontal scleral incisions represent a safe, reproducible, and effective modification for Carlevale IOL implantation, minimizing scleral manipulation and suture-related complications.