Retropupillary iris-claw intraocular lens in aphakic eyes

Abstract

In their study of iris-fixation aphakic intraocular lens (IOL) implantation in eyes without adequate capsule support, Gonnerman et al.1 indicated that iris-fixated aphakia IOLs were “the latest version of iris-fixated posterior chamber IOLs.” This statement is not correct since the Artisan aphakic IOL (Ophtec BV), developed by Jan G.F. Worst, was introduced in Europe in 1978.A In 1994, Rijneveld et al.2 reported the implantation of an iris-fixated IOL on the posterior iris surface in 7 eyes without adequate capsule support during penetrating keratoplasty (PKP) (Figure 1). Other authors have erroneously claimed to be the first group to describe the technique; for example, Mohr et al. in 20023 and Dighiero et al. in 2006.4Figure 1: Rijneveld’s technique (1994) of retropupillary fixation of an iris-fixated IOL. Reprinted with permission of author.Similar to Gonnermann et al., our experience using the aphakic iris-fixation IOL (Artisan) fixated on the posterior surface of the iris has also been positive. In the past 5 years, we have implanted 22 IOLs in combination with PKP or Descemet-stripping automated endothelial keratoplasty and 54 IOLs as a procedure to correct aphakia (41 as planned secondary implantation and 13 as a contingency procedure in cases of posterior capsule rupture). We used the 117.5 A constant (SRK/T formula5). Six months postoperatively, the corrected distance visual acuity (CDVA) was 20/40 or better in 36.6% of the PKP eyes and 74.1% of the eyes that had iris-fixation implantation only; the mean spherical equivalent was 0.05 diopter (D) ± 2.6 (SD) (range −3.50 to +3.50 D) and −0.62 ± 1.06 D (range −2.75 to + 1.25 D), respectively. A CDVA worse than 20/40 was related to concurrent macular disease or ocular surface problems. We have almost completely abandoned techniques such as suturing IOLs to the sclera or to the iris, and we agree with Gonnermann et al.1 that in these challenging cases with absence of capsule support, retropupillary iris-fixated IOL implantation is a very good option. We have also implanted iris-fixation aphakic IOLs in special cases, such as anterior megalophthalmos.6