Long-term follow-up of retropupillary iris-claw intraocular lens implantation: a retrospective analysis

Abstract

BackgroundThe ideal intraocular lens in cases of aphakia without capsular support is debated. Choices include anterior chamber lenses, iris- or scleral-sutured lenses, and iris-claw lenses. Our aim was to report our long-term evaluation of the use of retropupillary implantation of the Artisan iris-claw intraocular lens (RPICIOL) in several aphakic conditions without capsular support.MethodsA retrospective analysis of consecutive 320 eyes of 320 patients (222 males and 98 females) without capsular support in which we performed RPICIOL implantation in post-traumatic aphakia (141 eyes, group 1), post-cataract surgery aphakia (122 eyes, group 2), and in cases in which penetrating keratoplasty was associated with vitrectomy (57 eyes, group 3). Either anterior or posterior vitrectomy procedures were performed with 20–, 23-, or 25-gauge techniques for different associated anterior or posterior segment indications. We reviewed the refractive outcome, anatomical outcome, long-term stability of the implants, and possible long-term complications.ResultsThe mean patient age was 59.7 years (range, 16–84 years) in group 1; 60.1 years (range, 14–76 years) in group 2; and 65.8 years (range, 25–71.5 years) in group 3. The mean follow-up time was 5.3 years (range, 1 month to 8 years). At the end of the follow-up period, the mean post-operative best-corrected LogMAR visual acuity was 0.6 (range, perception of light to 0.3) in group 1; 0.3 (range, 0.5–0.1) in group 2; and 0.6 (range, hand movement to 0.2) in group 3. Disenclavation of RPICIOLs occurred in three cases because of slippage of one of the iris-claw haptics and spontaneous complete posterior dislocation occurred in one case. One case presented with retinal detachment, and no cases of uveitis were observed. Eight cases complained of chronic dull pain, and severe iridodonesis was seen in five cases. One case of post-operative macular edema was observed without post-operative increase in the mean intraocular pressure. There was no statistically different change in the endothelial cell density (cells/mm2) at the end of the follow-up period.ConclusionsRPICIOL for secondary implantations is a valid alternative strategy to scleral-fixated or angle-supported IOL implantation.

Clinical Course Followed Up in Contact Lens Applications of Traumatic Aphakia Contact Lens Applications of Traumatic Aphakia

“…Placement of lens inside the eye is an effective means of treatment in cases where capsule support is available. But in cases where capsule support from behind is not possible, it is mandatory to place an intraocular lens (IOL) to the anterior chamber, and an IOL fixation or a IOL implantation attached to the iris to the anterior chamber [6][7][8][9][10][11]. But in case the eye has been exposed to trauma, damage may be caused in the anterior chamber intraocular lenses foremost at the endothelium, the angle and the iris.…”

“…Risk of development of secondary glaucoma increases. Fixation to posterior chamber may cause conjunctiva and erosion due to suture in sclera, deviation in the IOL or dislocation of IOL [6][7][8][9][10].…”

Results of scleral fixated intraocular lens implantation

“…The ideal lens in aphakic patients without sufficient capsular support is controversial. Anterior chamber lenses, lenses sutured to the iris or sclera, or iris-claw lenses can be used (8). Each of these options has its own risks and complications.…”

Retropupilar positioning of foldable iris-claw intraocular lens for correction of aphakia with no capsular support

“…ICIOL implantation has been used more commonly over the last decade 3. Although originally designed for fixation on the anterior surface of the iris, some case series showed some advantages of fixating the ICIOL retropupillary, namely, by maintaining the AC depth and reducing the corneal endothelial cell loss 4,5…”