Outcomes of Iris-Claw Anterior Chamber versus Iris-Fixated Foldable Intraocular Lens in Subluxated Lens Secondary to Marfan Syndrome

Abstract

To compare the outcome of phacoemulsification using 2 different iris-fixation techniques for intraocular lens (IOL) replacement, a foldable posterior chamber IOL (PCIOL; AcrySof MA60AC, Alcon Laboratories Inc, Fort Worth, TX) and an iris-claw anterior chamber IOL (ACIOL; Artisan, Ophtec BV), for treatment of subluxated lenses in patients with Marfan syndrome (MFS). Randomized, controlled trial. A total of 31 eyes of 16 patients with subluxated lenses associated with MFS and a preoperative corrected visual acuity (CVA) < or =20/40 based on the Early Treatment Diabetic Retinopathy Study chart. Patients were enrolled and the eye with worse visual acuity was randomly assigned to 1 of 2 study arms: phacoemulsification and iris-fixated PCIOL or phacoemulsification and iris-claw ACIOL; the second eye of the same patient received the other IOL type. Preoperative and postoperative ophthalmologic examination, optical coherence tomography, and endothelial cell counts were performed. We recorded CVA results at 3, 6, and 12 months, complications, endothelial cell loss, and central retinal thickness. In the iris-fixated PCIOL group, CVA was significantly improved at 3 (P = 0.011; n = 16), 6 (P = 0.006; n = 16), and 12 months (P = 0.002; n = 16). In the iris-claw ACIOL group, CVA was significantly improved at 3 (P = 0.001; n=15), 6 (P = 0.001; n = 15), and 12 months (P = 0.009; n = 12). The CVA results did not differ significantly between groups. Dislocation of the IOL occurred in 3 of 16 (18.75%) eyes in the PCIOL group. Retinal detachment occurred in 3 eyes (2 in the PCIOL group and 1 in the ACIOL group) and was successfully repaired. Postoperative foveal tomograms in both groups revealed a decrease in the mean foveal thickness (MFT; < or =172 microm) in 54.16% of the patients. The iris-sutured PCIOL and iris-claw ACIOL produced comparable improvements in CVA at 3, 6, and 12 months postoperatively. Although IOL dislocation tended to occur more frequently in the iris-fixated PCIOL group, the difference was not significant. At 6 months postoperatively, all study patients tended to have a thinner MFT. None of the patients in either group developed cystoid macular edema.