Carlevale Versus Yamane Sutureless Scleral Fixation: Clinical and Swept-Source AS-OCT Comparative Analysis in Eyes Without Capsular Support

Purpose: We aimed to compare the anatomical and functional outcomes, postoperative complications, and intraocular lens (IOL) positioning of two different techniques of sutureless scleral fixation: the Yamane double-needle flanged technique and the Carlevale intraocular lens. Methods: This retrospective, single-center, comparative observational study included 100 eyes of 100 patients who underwent secondary scleral-fixated IOL implantation between January 2021 and December 2024. Sixty-nine eyes underwent Yamane fixation and 31 eyes received a Carlevale IOL. Best-corrected visual acuity (BCVA), postoperative complications, and anatomical stability were evaluated. In a subgroup of 33 patients, IOL tilt and decentration were objectively assessed at 6 months using second-generation swept-source anterior segment optical coherence tomography (AS-OCT; Casia 2, Tomey, Nagoya, Japan). Results: Both techniques provided significant visual improvements compared with baseline. AS-OCT demonstrated comparable anatomical stability between groups, with mean tilt values of 6.9° and 6.4° and mean decentration values of 0.61 mm and 0.48 mm for the Yamane and Carlevale groups, respectively, without statistically significant differences. Cystoid macular edema was observed numerically more often in the Yamane group (23.1% vs. 15.4% at 6 months; p = 0.604), and anterior chamber blood Tyndall effect was recorded respectively in 13% vs. 6% of eyes; these differences were not statistically significant. Early postoperative complications were generally mild and self-limiting in both groups. Conclusions: Both the Yamane technique and the Carlevale IOL were associated with significant visual improvement and acceptable safety profiles for secondary sutureless scleral fixation in eyes without adequate capsular support. In this sample the Carlevale IOL showed a trend toward better centration, whereas second-generation swept-source AS-OCT proved to be a valuable objective imaging modality for the postoperative evaluation of scleral-fixated IOLs. Larger prospective multicenter studies are needed to confirm these findings.