Assessment of the safety and efficacy of primary retropupillary fixation of iris-claw intraocular lenses in children with large lens subluxations.

Abstract

To evaluate whether retropupillary fixation of the iris-claw intraocular lens (IOL) is a safe and effective treatment option in children with large lens subluxations. Fourteen eyes of children between the ages of 8-17years with lens subluxations more than 7 clock hours underwent pars plana lensectomy-vitrectomy with implantation of the iris-claw IOL in the retropupillary position as a primary procedure. The best corrected visual acuity (BCVA), intraocular pressure (IOP), corneal endothelial count (EC) and the lens position using ultrasound biomicroscopy (UBM) were assessed pre- and postoperatively. Postoperatively, all patients had an increase in the BCVA with a mean of 0.351±0.154 logMAR units which was statistically significant as compared to the preoperative value of 0.771±0.132 logMAR units (p=0.003). The difference between the mean preoperative IOP (13.642±2.437mmHg) and the mean postoperative intraocular pressure at the end of 6months (13.5±2.244mmHg) was not statistically significant (p=0.671). The mean EC decreased by 0.99% from 2838.42±474.76 cells/mm2 preoperatively to 2810±461.24 cells/mm2 at the end of 6months postoperatively (p=0.117). The lens position was analyzed using UBM and was found to be parallel to the iris plane in all cases at the end of 6months. Our study shows that primary retropupillary iris-claw IOL implantation can be a safe and efficacious option for children with large (>7 clock hours) lens subluxations that is at least comparable to scleral-fixated PCIOLs.