Retropupillary iris claw intraocular lens implantation in aphakia for dislocated intraocular lens

Abstract

BackgroundNowadays, dislocated intraocular lenses (IOLs) and inadequate capsular support are becoming a challenge for every ophthalmic surgeon. Explantation of dislocated IOL and iris claw IOL (ICIOL) are the techniques that have been used in our ophthalmic department. The aim of this study is to report our technique for retropupillar ICIOL.MethodsThis study is a retrospective case series. A total of 105 eyes with dislocated IOL from the patients at the Department of Ophthalmology in Santa Maria Hospital, a tertiary reference hospital in Lisbon, Portugal, from January 2012 until January 2016, had been analyzed. Of these 105 eyes, 66 eyes had dislocated one-piece IOL and 39 eyes had dislocated three-piece IOL. The latter underwent iris suture of the same IOL and were excluded from this study. The remaining 66 eyes with dislocated one-piece IOL underwent pars plana vitrectomy, that is, explantation of dislocated IOL through corneal incision and an implantation of retropupillary ICIOL. Operative data and postoperative outcomes included best corrected visual acuity, IOL position, intraocular pressure, pigment dispersion, clinical signs of endothelial cell loss, and anterior chamber depth.ResultsThe mean follow-up was 23 months (range: 6–48 months). The mean preoperative best corrected visual acuity was 1.260±0.771 logMAR, and postoperative best corrected visual acuity was 0.352±0.400 logMAR units. Mean vision gain was 0.909 logMar units. The patients had the following complications: 1) retinal detachment was found in one patient, 2) corneal edema was found in three patients, 3) high intraocular pressure was observed in twelve patients, 4) subluxation of the IOL was observed in one patient, and 5) macular edema was found in three eyes.ConclusionThe results demonstrate that retropupillary ICIOL is an easy and effective method for the correction of aphakia in patients not receiving capsule support. The safety of this procedure must be interpreted in the context of a surgery usually indicated in complicated cases.

Dislocated Intraocular Lens Extraction and Iris-Claw Lens Implantation in Vitrectomized and Non-vitrectomized Eyes

“…Reported complications of ICIOL implantation include endothelial cell loss, corneal decompensation, pigment dispersion, hyphema, transient IOP elevation, secondary glaucoma, IOL dislocation, pupillary block, anterior uveitis, cystoid macular edema, hypotonia, choroidal detachment, retinal detachment, and vitreous hemorrhage. 6,7,10,11,12,13,14,15,16,17,18,19,20,21,22,23 None of the patients in this study showed pigment dispersion, uveitis, cystoid macular edema, hypotonia, choroidal detachment, retinal detachment, or vitreous hemorrhage within the first postoperative year, while other complications occurred at rates considered acceptable in terms of safety, as stated in the literature.…”

“…Although ICIOL implantation in aphakic eyes is easier and safer than other methods, complication rates vary widely between publications. 6,7,10,11,12,13,14,15,16,17,18,19,20,21,22,23 These differences may result from variation in surgical histories, placement of the ICIOL in the anterior chamber or retropupillary space, and surgeon experience. Reported complications of ICIOL implantation include endothelial cell loss, corneal decompensation, pigment dispersion, hyphema, transient IOP elevation, secondary glaucoma, IOL dislocation, pupillary block, anterior uveitis, cystoid macular edema, hypotonia, choroidal detachment, retinal detachment, and vitreous hemorrhage.…”

“…They also reported complications that were not observed in our study, such as cystoid macular edema (25%), retinal detachment (12.5%), vitreous hemorrhage (12.5%), and choroidal detachment (3%), at higher rates than other studies that employed a similar surgical procedure. 6,23 This difference may be related to operative time. In two studies conducted in vitrectomized aphakic eyes instead of eyes with dislocated IOLs as in our study, Acar et al 18 reported a 24% decrease in ECD over a mean follow-up period of 15 months, while Riazi et al 19 reported an ECD decrease of 8.1% at 6 months.…”

“…5 ICIOL implantation, on the other hand, is easier, quicker, and associated with low intraoperative and postoperative complication rates. 6 Although designed primarily for placement on the anterior surface of the iris, retropupillary placement is also possible. 7…”

Implantation of a double iris-claw intraocular lens in an aphakic nanophthalmic eye

“…[ 3 ] In addition, sclerally fixated IOLs also have some drawbacks such as retinal detachment, IOL decentration, conjunctival erosion, and endophthalmitis. [ 7 ]…”