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Purpose <p>Carlevale and retropupillary iris-claw Artisan intra-ocular lenses (IOLs) treat aphakia without capsular support, but their relative performance is uncertain.</p> Methods <p>PubMed, Embase and the Cochrane Library were searched to March 2025. Primary outcomes: best-corrected visual acuity (BCVA), surgically induced astigmatism (SIA), mean absolute refractive error (MARE) and mean refractive error (MRE). Secondary outcomes: operating time and postoperative complications. Random-effects meta-analysis with I² and incision-type subgroups was performed.</p> Results <p>Five studies comprising 631 eyes (229 Carlevale, 402 iris-claw) met inclusion criteria. Mean age was 70.1 ± 14.1 years, 61.18% were male; follow-up ranged from 1.3 to 11.5 months. BCVA did not differ between groups (− 0.01 logMAR; 95% CI − 0.13 − 0.11; <i>p</i> = 0.91; I²=43%). Carlevale reduced SIA (− 0.53D; 95% CI − 1.03 to − 0.04; <i>p</i> = 0.03; I²=73.7%), however, the benefit was confined to corneal-incision iris-claw comparators, not scleral-incision. MARE showed no overall difference, yet corneal-incision iris-claw cases were less predictable (MD-0.32; 95% Cl: -0.62-0.19, <i>p</i> = 0.30, I² =81.7%). Carlevale produced a myopic shift relative to iris-claw (− 0.66D; 95% CI − 0.87 to − 0.46; <i>p</i> &lt; 0.01; I²=31.3%). Carlevale procedures were 11.9&#xa0;min longer (95% CI 5.2–18.6; <i>p</i> &lt; 0.01; I²=80.2%). Complication rates were comparable overall except for fewer IOL dislocations with Carlevale (OR 0.16; 95% CI 0.03–0.87; <i>p</i> = 0.034; I²=0%).</p> Conclusions <p>Both lenses provide similar visual acuity and safety in aphakic eyes lacking capsular support. Carlevale confers lower dislocation risk and greater refractive predictability relative to corneal-incision iris-claw implantation, at the expense of a longer operating time. Incision-related heterogeneity highlights the need for standardised surgical and reporting frameworks.</p> Graphical Abstract <p></p>

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Comparison of Carlevale and Artisan retropupillary iris-claw intraocular lens fixation for managing aphakia: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月6日

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  • Omar Alghaith,
  • Tiago Nelson de Oliveira Rassi,
  • Negin Sanadgol,
  • Ehtesham Shamsher,
  • Victor Barreiros Pungirum,
  • Tran Bao Nghi,
  • Fatemeh Khabazianzadeh,
  • Maurício Maia

摘要

Purpose

Carlevale and retropupillary iris-claw Artisan intra-ocular lenses (IOLs) treat aphakia without capsular support, but their relative performance is uncertain.

Methods

PubMed, Embase and the Cochrane Library were searched to March 2025. Primary outcomes: best-corrected visual acuity (BCVA), surgically induced astigmatism (SIA), mean absolute refractive error (MARE) and mean refractive error (MRE). Secondary outcomes: operating time and postoperative complications. Random-effects meta-analysis with I² and incision-type subgroups was performed.

Results

Five studies comprising 631 eyes (229 Carlevale, 402 iris-claw) met inclusion criteria. Mean age was 70.1 ± 14.1 years, 61.18% were male; follow-up ranged from 1.3 to 11.5 months. BCVA did not differ between groups (− 0.01 logMAR; 95% CI − 0.13 − 0.11; p = 0.91; I²=43%). Carlevale reduced SIA (− 0.53D; 95% CI − 1.03 to − 0.04; p = 0.03; I²=73.7%), however, the benefit was confined to corneal-incision iris-claw comparators, not scleral-incision. MARE showed no overall difference, yet corneal-incision iris-claw cases were less predictable (MD-0.32; 95% Cl: -0.62-0.19, p = 0.30, I² =81.7%). Carlevale produced a myopic shift relative to iris-claw (− 0.66D; 95% CI − 0.87 to − 0.46; p < 0.01; I²=31.3%). Carlevale procedures were 11.9 min longer (95% CI 5.2–18.6; p < 0.01; I²=80.2%). Complication rates were comparable overall except for fewer IOL dislocations with Carlevale (OR 0.16; 95% CI 0.03–0.87; p = 0.034; I²=0%).

Conclusions

Both lenses provide similar visual acuity and safety in aphakic eyes lacking capsular support. Carlevale confers lower dislocation risk and greater refractive predictability relative to corneal-incision iris-claw implantation, at the expense of a longer operating time. Incision-related heterogeneity highlights the need for standardised surgical and reporting frameworks.

Graphical Abstract