Long-term surgical outcomes of primary retropupillary iris claw intraocular lens implantation for the treatment of intraocular lens dislocation

Abstract

We aimed to investigate the efficacy and safety of primary retropupillary iris claw intraocular lens (R-IOL) implantation in patients with complete intraocular lens (IOL) dislocation. In this single-center retrospective case series, we reviewed the medical records of patients who underwent R-IOL implantation surgery with pars plana vitrectomy for the treatment of IOL dislocation between September 2014 and July 2019. The primary outcome was change in visual acuity (VA) up to 24 months postoperatively. The secondary outcomes included changes in intraocular pressure (IOP), refractive errors, and endothelial cell count (ECC) over the same period. Data of 103 eyes (98 patients) were analyzed. The mean uncorrected VA was significantly improved at one month postoperatively (− 0.69 logMAR, P < 0.001), compared to the preoperative value. IOP (− 2.3 mmHg, P = 0.008) and ECC (− 333.4 cells/mm2, P = 0.027) significantly decreased one month post-surgery and remained stable thereafter. Postoperative mean spherical equivalents were similar to the prediction error throughout the follow-up period. IOP elevation (n = 8, 7.8%), cystoid macular edema (n = 4, 3.9%), and dislocation of the R-IOL (n = 10, 9.7%) were managed successfully. Overall, primary R-IOL implantation with pars plana vitrectomy is effective and safe for correcting IOL dislocation due to various causes.

Refractive Outcomes of Retropupillary Fixated Iris-Claw Lens for Exchange of the Dislocated Intraocular Lens Using Modified Scleral Incisions

“…Increased postoperative astigmatism after IOL exchange has always been a critical hurdle for good postoperative vision. 6 , 11–13 Kristianslund et al reported that the mean SIA magnitude was 1.12 ± 0.85 D at 6 months after a 5.5-mm scleral pocket arcuate incision and retropupillary iris-claw IOL implantation, which was significantly higher than the SIA of the IOL reposition. 13 Choi et al also reported a significant increase in corneal astigmatism after a 5.5-mm sclerocorneal incision and retropupillary iris-claw IOL implantation; although, no information regarding SIA was included in the data.…”

“… 6–11 However, because the IOL is rigid, its implantation requires a large sclerocorneal incision, which often results in high surgically induced astigmatism (SIA). 9 , 11–13 …”

Retropupillary Iris-Claw Intraocular Lenses: A Literature Review

“… 32 Choi et al showed that the ECL was not significant after 1 month postoperatively, signifying that the ECL was mainly due to factors related to surgery rather than the problem of ICIOL itself. 27 Forlini et al observed no significant ECL after 5 years of follow-up. 36 …”

“… 68 Studies on retropupillary ICIOL have shown a considerable variation in ECL ranging from 3%-43%. 14–16 , 23 , 25 , 27 , 28 , 30–33 , 36 , 42–44 , 46 , 47 , 49–51 , 56 Dalby et al, in a prospective comparative clinical trial, observed no significant difference in ECL following ICIOL implantation (15%) and IOL repositioning (18%) for late in-the-bag IOL dislocation at the end of 2 years. 64 In contrast, Kristianslund et al reported a significant postoperative ECL of 10% in the ICIOL group and a non-significant postoperative ECL of 3% in the repositioning group.…”

“… 21 Choi et al stated that the IOP elevation in their study might be due to inflammation caused by vitrectomy rather than the ICIOL itself. 27 Forlini et al reported no cases of pupillary block and attributed it to the vaulting design of the ICIOL and the appropriate space between the optic of the ICIOL and the posterior surface of the iris. 36 Kelkar et al, in their retrospective comparative study, experienced a transient rise of IOP more in eyes with scleral-fixated IOL (17%) than ICIOL (8%), which was managed with topical therapy.…”