Is an iris claw IOL a good option for correcting surgically induced aphakia in children? A review of the literature and illustrative case study

Abstract

Refractive correction of aphakia in childhood can be a complex management issue following lensectomy for congenital cataract or ectopia lentis. Some children have inadequate capsular support to allow an 'in the bag' or sulcus fixated intra-ocular lens (IOL). In such cases, options for refractive correction include spectacles, contact lenses, or surgically fixed IOLs. Many methods of IOL fixation have been described, but none are widely adopted in children. In recent years, the iris-fixated Artisan Aphakic IOL has gained popularity, but there is still significant concern about the rate of corneal endothelial cell loss and IOL de-enclavation. Here, we review the current literature on the use of iris-fixated IOLs in children, the published data on endothelial cell loss and de-enclavation rates. We present a case illustrating the significant improvements in quality of life, which can be seen in selected children, and also the rate of endothelial cell loss, which can be encountered after initial surgery, and a re-enclavation event. We make the case that until more data are available on normal endothelial cell decline in early childhood, in addition to age-specific rates of endothelial cell loss and de-enclavation rates following surgery, the use of iris-fixated IOLs in children will continue to be a moot point and is unlikely to be widely adopted.

Evaluation of Sutureless, Glueless, Flapless, Intrascleral Fixated Posterior Chamber Intraocular Lens in Children with Ectopia Lentis

“…Since the tips of the haptics were buried intrasclerally, conjunctival erosion was not seen in any of the eyes. This also reduced the chances of late-onset endophthalmitis as suture erosion can serve as a direct communication channel between the outside environment and the eye [ 9 ].…”

“…Firstly, the scleral tunnels have been demonstrated, using anterior segment ultrasound, to achieve a leak-free closure even without the application of glue [ 21 ]. Avoiding the use of glue not only reduces the cost of surgery, but also avoids the theoretic chance of transmission of infectious agents associated with the use of glue [ 9 , 18 ]. Even in our study, no case of postoperative hypotony or choroidal detachment was seen in our study.…”

“…By the virtue of its near physiological anatomical location, such complications are rare in the case of SFIOL [ 6 , 7 , 9 – 13 ]. However, suspending the SFIOL with the help of 10-0 polypropylene suture is associated with a number of suture-related complications like suture erosion, suture knot exposure, and recurrent dislocation(s) due to dissolution of the suture with time [ 1 – 16 ].…”

Sutureless Scleral-Fixated Intraocular Lens Implantation for Refractive Rehabilitation in Eyes With Spherophakia

“…4 Recently iris-supported ACIOLs have been used in pediatric patients with aphakia with good visual outcome and no significant effect on the endothelium; however, concerns remain regarding chronic uveitis leading to PAS and glaucoma, iris chaffing, and pupillary constriction. 8,9,12 Placing a posterior chamber IOL in the capsular bag is controversial because the zonules in spherophakic eyes are developmentally weak, and there is a possibility of the bag-lens complex dropping into the vitreous. 13 A dual-support technique with a capsular tension ring and segment has been described in a case of spherophakic eyes to overcome zonular weakness.…”

Screening, genetics, risk factors, and treatment of neonatal cataracts

“…To reduce the necessity of IOL exchange, patients should be undercorrected by 10 to 20%, with the residual refractive error corrected by spectacles that are continually adjusted throughout life, according to refractive development (Dahan and Drusedau, ). In terms of the type of IOLs, the posterior chamber IOLs in‐the‐bag implantation is most recommended in pediatric aphakic eyes (Luo et al, ), anterior chamber IOLs and iris‐fixated IOLs may be used in some children who have inadequate capsular support, but are unlikely to be widely adopted (Barbara et al, ).…”