Modified Carlevale intraocular lens implantation using scleral pockets and trocar-assisted plug externalization

Abstract Background The Carlevale intraocular lens is designed for sutureless scleral fixation in eyes without adequate capsular support. We describe a modified implantation technique combining scleral pockets with trocar-assisted plug externalization and report the surgical and early clinical outcomes of a consecutive case series. Methods This retrospective consecutive case series included 24 eyes undergoing modified Carlevale FIL SSF Monofocal intraocular lens implantation using scleral pockets and 25-gauge trocar-assisted plug externalization between December 2023 and July 2025. All eyes underwent 25-gauge pars plana vitrectomy, peripheral retinal examination with scleral indentation, and inferior peripheral iridectomy. The main outcome was technical feasibility, defined as successful plug externalization and stable scleral fixation. Secondary outcomes included best-corrected visual acuity, intraocular pressure, surgical time, endothelial cell density, central corneal thickness, lens stability, plug exposure, and complications. Continuous outcomes were summarized descriptively, and paired comparisons were performed using the Wilcoxon signed-rank test. Results The technique was performed in 24 eyes. Mean age was 70.5 ± 9.4 years, and 14 eyes (58.3%) were from male patients. The most common indications were aphakia (8 eyes, 33.3%), subluxated intraocular lens (7 eyes, 29.2%), and dislocated intraocular lens (5 eyes, 20.8%). Mean surgical time was 67.3 ± 15.8 min. Mean best-corrected visual acuity improved from 0.34 ± 0.28 logMAR at baseline to 0.20 ± 0.28 logMAR at 3 months, 0.16 ± 0.17 logMAR at 6 months, and 0.14 ± 0.15 logMAR at 1 year. Intraocular pressure remained stable throughout follow-up. No postoperative hypotony, reverse pupillary block, plug exposure, endophthalmitis, or lens dislocation was observed. De novo postoperative cystoid macular edema occurred in 3 eyes (12.5%). Conclusions This modified Carlevale intraocular lens implantation technique integrates scleral pockets with trocar-assisted plug externalization within the pars plana vitrectomy workflow. In this consecutive series, the technique was feasible and associated with stable early anatomical and functional outcomes. Larger comparative studies with longer follow-up are required to determine whether this approach reduces leakage, plug exposure, or surgical time compared with conventional techniques. Trial registration Not applicable.