Iris-claw Iris-claw Intraocular Lens Implantation Research Articles

Outcomes of Iris-Claw IOL Implantation in Patients with Marfan's Syndrome in Jordan.

The management of ocular complications of Marfan's syndrome, especially ectopia lentis, is challenging. In this study, we present the effectiveness and the safety of iris-claw intraocular lens (IOL) implantation along with lensectomy for those patients. Also, we compare the practice of implanting these IOLs either in the anterior chamber of retropupillary. Retrospectively, we included all patients with Marfan's syndrome who underwent lensectomy with iris-claw IOL implantation as a result of ectopia lentis. The patients were categorized into two groups: anterior chamber iris claw IOL and retropupillary iris-claw IOL. The clinical and demographic data, the visual outcome and postoperative complications were compared. Eighteen eyes of 10 patients were included in the study. The mean age of the patients was 19.1 years. Six patients were males. The iris-claw IOL was implanted anteriorly in 13 eyes. The visual outcome was comparable between both groups and most patients achieved improvement in the visual acuity. In addition, the postoperative complications developed similarly in both groups. However, all cases of IOL disenclavation (6 cases) developed in the anterior group. It is revealed that the age of the patient was the most significant factor affecting the occurrence of IOL disenclavation. Iris-claw IOL (either anteriorly or retropupillary) is an effective and relatively safe method in treating ectopia lentis in patients with Marfan's syndrome. In younger patients, anterior iris-claw IOL is safer than retropupillary iris-claw IOL as the risk of disenclavation is higher in younger patients.

Incidence of Glaucoma after Combined Descemet's Stripping Endothelial Keratoplasty and Retropupillary Fixated Iris-Claw Lens.

To assess the incidence of glaucoma after combined Descemet's stripping endothelial keratoplasty (DSEK) and retropupillary fixated iris-claw intraocular lens (IOL) implantation in the patients with bullous keratopathy (BK) who required secondary IOL or IOL exchange. In this retrospective case series, medical records of 22 patients who underwent combined DSEK and retropupillary fixated iris-claw IOL implantation were evaluated. Preoperative vision, intraocular pressure (IOP), postoperative IOP at different time periods, and intraoperative and postoperative complications were analyzed. A total of 22 eyes of 22 patients (7 females and 15 males) were analyzed. The median age was 62 years, and the median duration of the postoperative follow-up was 106.5 days. The corrected distance visual acuity improved from a median of 1.85 logMAR to 1.68 logMAR. None of the patients had intraoperative complications. Three patients (13.6%) had dislocation of the donor tissue on the 1st postoperative day and were successfully rebubbled. Six eyes (27.3%) had graft failure and required penetrating keratoplasty. Eleven eyes (50%) had a sustained rise in the IOP, of which 2 (9.09%) had ocular hypertension and 9 eyes (40.9%) progressed to glaucoma. DSEK combined with retropupillary fixated iris-claw lens is a good surgical option for the management of aphakic/pseudophakic BK in patients who require secondary IOL or IOL exchange. Regular IOP monitoring after the surgery is an essential, as there is a risk of IOP rise and glaucoma in the postoperative period. Clinicians should be vigilant and control the IOP to prevent glaucoma progression.

Simultaneous Management of Retinal Detachment and Aphakia with Pars Plana Vitrectomy, Silicone Oil Tamponade and Retropupillary Iris-Claw Intraocular Lens Implantation in These Cases.

Marfan Syndrome is an autosomal dominant disease with multiple ocular abnormalities including ectopia lentis and a high incidence of rhegmatogenous retinal detachment (RRD). The management of RRD may be challenging in cases of aphakic patients with Marfan. To report on the management of four cases of simultaneous RRD and aphakia with vitrectomy, silicone oil tamponade, and retropupillary iris-claw intraocular lens (IOL) implantation in patients with Marfan that have been operated at the Jules-Gonin Eye Hospital between 2019 and 2020. Ages at presentation were 20, 30, 32, and 31 years, respectively. All patients had a history of extraction of a dislocated lens. None of the patients had a previous posterior vitrectomy. Two patients had records of previous measurements for IOL calculation by optical biometry (IOL Master, Carl Zeiss Meditec AG, Jena, Germany) about 1 year prior to the RRD development. In two cases, measurements for IOL calculation by optical biometry were based on the contralateral eye. All patients underwent 23 G vitrectomy, peripheral iridotomy, and retropupillary iris-claw IOL. No intraoperative complications were encountered. All patients had silicone oil tamponade, one of which required heavy silicone oil. Silicone oil was removed 3 months following primary surgery. Minimum follow-up was 1 year. The single surgery anatomic success rate was 100%. All patients had visual acuity of at least 0.8 at the last follow-up (1.25, 1.0, 0.8, and 0.8 respectively). The targeted refractive results were accurately achieved in all four cases postoperatively. One patient presented ocular hypertension 2 weeks after surgery due to presumed steroid response and was managed conservatively. None of the patients had silicone oil migration into the anterior chamber. Retropupillary iris-claw IOL implantation in cases of RRD and aphakia creates a barrier to tamponades from the posterior segment, effectively preventing them from entering the anterior segment of the eye. Therefore, the management of aphakia and retinal detachment with simultaneous vitrectomy and a retropupillary iris-claw IOL may be a successful strategy in reducing postoperative complications in patients with Marfan syndrome.

İris Arkasına İntraoküler Lens İmplantasyonu Uzun Dönem Sonuçlarımız ve Diğer Gözle Karşılaştırılması

Objective: To evaluate the long-term results of primary and secondary posterior iris-claw intraocular lens (IOL) implantation and a comparative analysis with the fellow eye Material and Methods: One hundred-one eye of 99 patients who underwent iris-claw IOL implantation were included in this retrospective study. Data recorded for each subject consisted of preoperative and postoperative spherical equivalent (SE), best-corrected visual acuity (BCVA), intraocular pressure (IOP), central corneal thickness (CCT), endothelial cell count (ECC) values, and biomicroscopic findings. Patients were divided into two main groups according to primary (complicated cases) and secondary (aphakic cases) implantation. The comparison of the groups was made in terms of SE, BCVA, IOP, CCT, and ECC values. Also, postoperative CCT and ECC comparison was made between the fellow eye and irisclaw IOL implanted eyes. Results: Median duration of follow-up was 44.6 (range 1-83) months. While postoperative SE, IOP, CCT values were similar in two groups (p=0.754, p=0.621, p=0.520, respectively), postoperative BCVA and ECC values were statistically higher in the aphakic group than the complicated group (p=0.048, p=0.004, respectively). ECC values in iris-claw IOL-implanted eyes were lower than the same patients' fellow phakic eyes (p=0.003), but there was no statistically significant difference between iris-claw IOL-implanted eyes and the fellow pseudophakic eyes for ECC values (p=0.520). Conclusion: Although retropupillary iris-claw IOL fixation with scleral tunnel might be challenging, it is a safe and effective method with better visual and refractive outcomes.

Safety and Efficacy of Artisan Aphakia Iris-Claw Intraocular Lens in Tertiary Hospital in Indonesia

Introduction: Iris-claw Intraocular Lens (IOL) is one of the alternatives to correct aphakia without sufficient capsular support. This technique is preferred because it has a simple procedure. Iris-claw IOL was originally designed to be fixated on the anterior chamber. The use of retropupillary fixation is increasing because the location is more physiologic and it shows less risk to corneal endothelial damage. Purpose: To describe safety and efficacy of iris-claw Artisan IOL in correcting aphakia without sufficient capsular support. Methods: This is a descriptive retrospective study of patients with aphakic iris-claw Artisan IOL implantation in National Eye Center Cicendo Eye Hospital, Indonesia from July 2017-July 2019. Patients were divided into prepupillary and retropupillary group. The Uncorrected Visual Acuity (UCVA), Best-Corrected Visual Acuity (BCVA), Safety Index (SI), Efficacy Index (EI), and complications were recorded. The procedure is safe if SI value ≥ 1.0 and effective if EI value ≥ 1.0. Results: There were 54 eyes in the retropupilary group and 17 eyes in the prepupillary group. In the prepupillary group, there were 94.11% eyes with SI ≥ 1.0, the mean SI was 1.79 ± 1.02, 50% of eyes with EI ≥ 1.0, and the mean EI was 0.77 ± 0.20. In the retropupillary group, there were 96.29% eyes with SI ≥ 1.0, the mean SI was 2.49 ± 2.23, 74.07% of eyes with EI ≥ 1.0, and the mean EI was 1.75 ± 1.64. Postoperative UCVA and BCVA were improved significantly compared to preoperative visual acuity in both groups (p < 0.05) Conclusion: Prepupillary and retropupillary iris-claw IOL implantation are safe. Retropupillary fixation technique is more effective in improving visual acuity.

Surgical Outcomes of Retropupillary-Fixated Iris-Claw Intraocular Lens

Purpose:To assess the visual outcome and complications following retropupillary-fixated iris-claw intraocular lens (IOL) implantation.Methods:For this retrospective, non-comparative study, chart review of patients who underwent retropupillary iris-claw IOL implantation for the correction of aphakia from July 2014 to October 2018 and had a minimum postoperative follow-up of 2 months was carried out. Postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), and complications were noted.Results:One hundred and twenty-two eyes of 122 patients (mean follow-up: 7.48 ± 5.2 months, range, 2 months-3.5 years) were enrolled in the study. The mean logMAR CDVA improved from 1.36 ± 0.52 preoperatively to 0.5 ± 0.42 postoperatively, at the last follow-up visit (P < 0.0001). The final CDVA improved in 110 eyes (90.2%), remained unchanged in 8 eyes (6.6%), and worsened in 4 eyes (3.3%). In cases of pre-existing cystoid macular edema (CME) or excessive intraoperative manipulations, 0.05 ml of 4 mg intravitreal triamcinolone acetonide (IVTA) was injected at the end of the surgery. Twenty eyes (16.4%) had transient ocular hypertension (OHT), 6 eyes (4.9%) had persistent OHT, and 2 eyes (1.6%) progressed to glaucoma. Choroidal detachment was noted in 2 eyes (1.6%), CME in 6 eyes (4.9%), 2 eyes (1.6%) had retinal detachment, 20 eyes (16.4%) had significant ovalization of pupil, 8 eyes (6.6%) had one haptic disenclavation, 1 eye (0.8%) had corneal decompensation, and 1 eye (0.8%) had endophthalmitis.Conclusions:Retropupillary iris-claw IOL provides good visual rehabilitation with a few complications. Its ease of insertion and short surgical time makes it a good option to correct aphakia in patients with an inadequate capsular support.

The use of iris claw intraocular lens in aphakic eyes with inadequate capsular support and in phakic eyes for correction of high refractive errors

Background Iris-claw intraocular lens (IOL) implantation is effective for correction of aphakia in the absence of capsular support. Iris claw phakic IOLs lack potential size-related complications that may occur with other phakic IOLs.Objective The aim of this study was to evaluate the technique, efficacy, and safety of iris claw IOL implantation.Patients and methods Patients with inadequate capsular support underwent aphakic iris-claw IOL implantation using two techniques: anterior chamber and retro-pupillary fixation of iris-claw lens. Phakic iris claw IOLs were implanted for myopic patients with high refractive errors or with thin or suspicious corneas. Eyes were evaluated for uncorrected and corrected distance visual acuity, refraction, intraocular pressure, and any postoperative complications.Results The study included 17 eyes. Group I included 12 eyes that underwent aphakic iris-claw lens implantation. Indications for surgery were surgical aphakia (n=8), lens dislocation (n=1), and lens subluxation (n=3). Eight eyes had pre-pupillary lens implantation and four eyes underwent retro-pupillary implantation. Group II included five eyes that underwent phakic iris-claw lens implantation. The final postoperative unaided visual acuity was 0.13±0.067 in group I and 0.22±0.076 in group, II, whereas the corrected visual acuity was 0.28±0.193 in group I and 0.34±0.114 in group II. The visual acuity improved significantly compared with the preoperative values (P=0.003 and 0.003, respectively, in group I and P=0.041 and 0.042, respectively, in group II). Postoperative complications included corneal edema, intraocular pressure elevation, inflammatory reaction, pupil ovalization, vitreous hemorrhage, and lens disenclavation.Conclusion Aphakic iris-claw IOL implantation is an effective option for visual rehabilitation in eyes with inadequate capsular support. Phakic iris-claw lens implantation is useful for correction of high refractive errors with high efficacy and safety.

Combined Pupilloplasty and Retropupillary Iris-Claw Intraocular Lens Implantation with DSAEK in a Patient with Traumatic Iridoplegia, Aphakia and Corneal Decompensation.

PurposeTo report the management of a patient with traumatic mydriasis, aphakia and corneal decompensation with a triple procedure: simultaneous pupilloplasty and retropupillary iris-claw intraocular lens (IOL) implantation combined with Descemet stripping automated endothelial keratoplasty (DSAEK).ResultsAn 88-year-old woman was referred to our Institute for consultation on her left eye. The patient had undergone surgical removal of the IOL, without re-implantation, in her left eye 10 months prior to presentation due to traumatic IOL dislocation. At the time of examination, corrected distance visual acuity was counting fingers and intraocular pressure was 10 mmHg. Slit-lamp examination revealed iridoplegia, aphakia and corneal edema. The patient underwent simultaneous pupilloplasty and retropupillary iris-claw IOL implantation combined with DSAEK. Six months postoperatively, the corneal graft was attached and clear, the iris was well reconstructed and almost round, and the iris-claw IOL was in place.ConclusionsSimultaneous pupilloplasty and retropupillary iris-claw IOL implantation combined with DSAEK was shown to be a safe surgical technique in a patient with traumatic mydriasis, aphakia and corneal decompensation.

Clinical outcome of iris-claw intraocular lens implantation

Aim: The aim of this study is to study the indications, visual outcome, and complications in patients undergoing iris-claw intraocular lens (IOL) implantation. Settings and Design: This is a prospective interventional case series conducted between January 2016 and June 2017 in a tertiary care hospital. Materials and Methods: Seventy-nine eyes of 78 patients with aphakia or subluxation of lens of various etiologies were included in the study. Complete ophthalmological examination was conducted. Retropupillary iris-claw IOL implantation was done in the included patients. Patients were followed-up to 6 months for visual acuity, intraocular pressure measurement, and complications. Statistical Analysis Used: Statistical analysis was performed by the Students t-test. Results: The difference between preoperative and postoperative visual acuity was statistically significant in the group of patients undergoing iris-claw IOL implantation as a primary procedure (P

Comparative Analysis of the Safety and Functional Outcomes of Anterior versus Retropupillary Iris-Claw IOL Fixation.

Purpose To compare the functional and clinical outcomes of the iris-claw intraocular lens (IOL) placed on the anterior versus posterior surface of the iris. Patients and Methods A multicenter, retrospective study. Data on eyes that underwent anterior or retropupillary iris-claw IOL implantation because of inadequate capsular support secondary to complicated cataract surgery, trauma, and dislocated/opacified IOLs since January 2015 were analyzed. For study inclusion, evaluation results had to be available in the medical records both preoperatively and at 1 and 12 months after implantation. The following parameters were compared between the groups: best-corrected distance visual acuity (BCDVA), spherical and cylindrical refractive error, endothelial cell density (ECD), central macular thickness (CMT), and percentage and type of postoperative complications. Results In total, 60 eyes of 60 patients aged 73 ± 13 years were included: 28 eyes (47%) involved anterior, and 32 eyes (53%) retropupillary, iris-claw IOL fixations. Preoperatively, the groups were similar in all parameters except for a significantly higher proportion of retropupillary fixations in patients who had previously experienced a closed-globe trauma (p=0.03). The groups showed comparable improvements in BCDVA after surgery (final BCDVA: 0.34 ± 0.45 vs. 0.37 ± 0.50 logMAR in the anterior and retropupillary placement groups, respectively). During follow-up, no group difference was observed in refractive error or CMT. Both groups experienced similarly marked ECD loss and showed similar incidence of postoperative complications, with cystoid macular edema being the most common complication. Multivariable linear regression showed that BCDVA at 1 month was the best predictor of the final BCDVA. Conclusions Anterior chamber and posterior chamber iris-claw IOL fixations proved equally effective and safe for aphakic correction in eyes with inadequate capsular support.

Iris-claw intraocular lens for aphakia: Can location influence the final outcomes?

To describe the demographic data, evaluate the long-term refractive and anatomical outcomes, and report the incidence of complications of anterior iris (prepupillary) and posterior iris (retropupillary) fixation of the Artisan aphakia iris-claw intraocular lens (IOL). Complejo Hospitalario Universitario de Santiago de Compostela, Spain. Retrospective case series. Patients who had iris-claw IOL implantation were divided into 2 groups: Group 1 (prepupillary) and Group 2 (retropupillary). The corrected distance visual acuity (CDVA), anatomical changes, endothelial cell count (ECC), presence of cystoid macular edema (CME), and operative and postoperative complications were determined. The study comprised 95 eyes of 95 patients. Fifty-seven patients had prepupillary implantation and 38 patients had retropupillary implantation. Indications for surgery were IOL luxation or subluxation (n=24), lens luxation or subluxation (n=17), trauma (n=15), aphakia (n=30), and other (n=9). The CDVA improved significantly in both groups and there were no differences between them. A significant ECC reduction was observed in both groups, with no differences between them. The incidence of CME was 16.1% (21.8% in the prepupillary group and 7.9% in the retropupillary group at 3months and 8months, respectively), although the difference was not statistically significant. Other postoperative complications were rare and no differences were found between groups. Irrespective of location, the iris-claw IOL provided good visual outcomes with few complications. However, prepupillary IOL implantation seemed to contribute to greater endothelial cell loss and earlier onset of CME.

Visual outcome and complications of posterior iris-claw intraocular lens implantation: A follow-up analysis

Purpose: The aim of this study was to assess the final visual outcome and various complications, encountered in the posterior iris-claw intraocular lens (IOL) implantation in aphakic eyes with inadequate capsular support. Methodology: Prospective case series of 30 eyes of 29 patients who underwent posterior iris-claw intraocular lens implantation in a tertiary care center within 1 year (January 2016 to June 2017) with a follow-up period of 6 months. All patients with visually significant posterior segment problems were excluded from the study. Main outcome measures were visual acuity, anterior chamber reaction, corneal edema, the stability of IOL, and cystoid macular edema (CME) at 6 months. Results: Of the 30 eyes enrolled in the study, 24 (86.7%) eyes were taken for elective secondary implantation. Four (13.3%) eyes were for primary iris-claw implantation, where subluxated or dislocated lens was noticed preoperatively. The indications for posterior iris-claw IOL in our study were surgical aphakia (24/30), traumatic subluxation of the cataractous lens (2/30), dislocated lens (2/30), and decentered posterior chamber IOL (2/30). Postoperative mean best-corrected visual acuity (BCVA) was LogMAR 0.3. Analysis of complications showed that the most common postoperative complications were iritis (36%), corneal edema (30%), striate keratitis (26.6%), hyphema (6.66%), iris capture (6.66%), and CME (3.33%). Conclusion: Surgical aphakia is the most common indication for posterior iris-claw IOL implantation. Postoperative mean BCVA is comparable with other methods. Iritis is the most common complication. This technique is a relatively safe and easy procedure learned by postgraduate students.

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

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.

Iris reconstruction combined with iris-claw intraocular lens implantation for the management of iris-lens injured patients.

Aim:To study the efficiency and safety of iris reconstruction combined with iris-claw intraocular lens (IOL) implantation in the patients with iris-lens injuries.Settings and Design:Retrospective, noncomparable consecutive case series study.Materials and Methods:Eleven patients (11 eyes) following iris-lens injuries underwent iris reconstructions combined with iris-claw IOL implantations. Clinical data, such as cause and time of injury, visual acuity (VA), iris and lens injuries, surgical intervention, follow-up period, corneal endothelial cell count, and optical coherence tomography, were collected.Results:Uncorrected VA (UCVA) in all injured eyes before combined surgery was equal to or <20/1000. Within a 1.1–4.2-year follow-up period, a significant increase, equal to or better than 20/66, in UCVA was observed in six (55%) cases, and in best-corrected VA (BCVA) was observed in nine (82%) cases. Postoperative BCVA was 20/40 or better in seven cases (64%). After combined surgery, the iris returned to its natural round shape or smaller pupil, and the iris-claw IOLs in the 11 eyes were well-positioned on the anterior surface of reconstructed iris. No complications occurred in those patients.Conclusions:Iris reconstruction combined with iris-claw IOL implantation is a safe and efficient procedure for an eye with iris-lens injury in the absence of capsular support.

Comparison of Artisan iris-claw intraocular lens implantation and posterior chamber intraocular lens sulcus fixation for aphakic eyes.

To compare the efficacy and complications of Artisan iris-claw intraocular lens (IOL) implantation and posterior chamber IOL sulcus fixation for the treatment of aphakic eyes without capsular support after vitrectomy. A prospective study of 45 cases was conducted. Forty-five eyes without sufficient lens capsule support following pars plana vitrectomy (PPV) combined lens extraction were divided into two groups. Group A: 25 eyes received Artisan iris-claw IOL implantation. Group B: 20 eyes received posterior chamber IOL sulcus fixation. The corrected distance visual acuity (CDVA) and intraocular pressure (IOP), corneal endothelial cell loss rate, surgical time and complications were compared between the two groups. Pigment changes of trabecular meshwork and anterior chamber depths were measured at each time point in Artisan group. The mean surgical time of Artisan group was significantly shorter (P<0.05). No statistically significant difference in endothelial cell loss rate was noted between two groups at any time point (P>0.05). CDVA of Artian group was better than that of the sulcus fixation group 1d after surgery (P<0.05) and there was no statistically significant difference 1 and 3mo after surgery (P>0.05). Mean IOP showed no significant differences between groups before and after surgery. The postoperative complications of Artisan group were anterior uveitis, iris depigmentation, pupillary distortion and spontaneous lens dislocation. The complications of sulcus fixation group include choroidal detachment, intraocular haemorrhage, tilt of IOL optic part and retinal detachment. Secondary Artisan IOL implantation can be performed less invasively and in a shorter surgical time period with earlier visual recovery after surgery compared to transscleral suturing fixation of an IOL. This technique is an effective and safe procedure. It is a promising option for the treatment of aphakic eyes without capsular support after vitrectomy.

Secondary iris-claw anterior chamber lens implantation in patients with aphakia without capsular support

Background/aimsTo evaluate the efficacy, predictability, safety and complications of secondary iris-claw intraocular lens (IOL) implantation in aphakic eyes without capsular support.MethodsRetrospective, non-comparative, interventional case series of 128 aphakic eyes, which...

Anterior Iris-Claw Lens Implantation with Single Paracentesis

In this study, the technique and results of iris-claw intraocular lens (IOL) implantation with corneal incision and single paracentesis were presented. Eighteen eyes of 18 patients who underwent iris-claw implantation surgery with a single paracentesis were included in this prospective study. Iris-claw lens was grasped by its forceps and placed into the anterior chamber through superior corneal opening. While IOL was held by forceps, a blunt enclavation spatula was introduced through inferior paracentesis. Then the spatula was directed toward underneath of iris through pupil and toward sides where iris was entrapped into the claw by gentle push of iris through the slotted center of the lens haptics. Mean age of patients was 54.28 ± 25.21 years (7–76 years). Mean anterior chamber depth was 4.07 ± 0.32 mm and mean keratometric power was 43.01 ± 2.73 D. Preoperative BCVA was 20/63 or better in 8 (44.4%) patients. At the first postoperative month BCVA was 20/63 or better in 14 (77.8%) patients. Preoperative mean spherical refraction was +11.05 ± 2.62 D, preoperative astigmatism was 2.15 ± 0.85. Postoperative mean spherical refraction was −0.58 ± 0.25 D and mean astigmatism was −1.92 ± 0.67 D. The most frequent postoperative complication was mild corneal edema seen in three patients that resolved completely during the first week with medical treatment. Irisclaw IOL implantation can be performed easily with corneal incision and single paracentesis. Single paracentesis does not increase surgical time or cause inconvenience during the procedure.

Posterior Iris Fixation of the Iris-Claw Intraocular Lens Implantation through a Scleral Tunnel Incision

To evaluate the technique, efficacy, and safety of posterior iris fixation of iris-claw intraocular lens (IOLs) implantation through a scleral tunnel incision for aphakia correction. Noncomparative, interventional case series. A secondary posterior iris fixation of the Artisan iris-claw IOL (Ophthec BV, Groningen, The Netherlands) was implanted for aphakia correction in the authors' clinical practice. Uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), astigmatism, manifest refraction, lens position, pigment dispersion, and intraocular pressure (IOP) were evaluated in 32 consecutive eyes of 32 patients. BSCVA was 20/40 or better in 28 eyes (87.50%) during the mean follow-up time (nine months). Mean postoperative spherical equivalent was -0.70 diopters (D; standard deviation [SD], 0.47 D) at six months after surgery. Mean prediction error was -0.13 D (SD, 0.28 D), and mean absolute prediction error was 0.26 D (SD, 0.15 D). Preoperative mean astigmatism was -1.08 D (SD, 0.55 D; range, 0.0 to -2.0 D). At six months after surgery, mean astigmatism was -2.1 D (SD, 0.81 D; range, -0.75 to -3.75 D). There was no significant postoperative IOP increase. Lens position, evaluated by Oculus Pentacam (Pentacam 70700: Oculus, Wetzlar, Germany) and ultrasound biomicroscopy [UBM] (Ophthalmic Technologies Inc, Toronto, Ontario, Canada), was parallel to the iris plane. Posterior iris fixation of the iris-claw IOL implantation through a scleral tunnel incision is a safe procedure and an effective option for aphakic eyes without capsule support.

Late spontaneous dislocation (disenclavation) of iris-claw intraocular lenses

We report 2 cases of late spontaneous dislocation (disenclavation) of an iris-claw intraocular lens (IOL) after cataract surgery. Case 1 was a 65-year-old woman who presented with diminution of vision in the left eye. She had left eye cataract surgery 17 years ago with iris-claw IOL implantation. In the left eye, there was temporal disenclavation of IOL and the free end was touching the endothelium at 4 o'clock position. Case 2 was a 32-year-old man who first presented in 1994. He was a high myope and had cataract extraction in both eyes with iris-claw IOL implantation 7 years ago. He presented in October 2003 with complaint of blurred vision in the left eye of 4 months' duration. In the left eye, the IOL had disenclavated temporally and was hanging inferiorly. Case 1 had IOL exchange. In Case 2, IOL exchange was advised.