Iris-claw Intraocular Lens Research Articles

Efficacy and Safety of Iris-Claw Intraocular Lens in Pediatric Ectopia Lentis: A Literature Review.

To review current evidence regarding the use of iris-claw intraocular lens (IOL) in terms of its efficacy and safety in the population of pediatric ectopia lentis. A comprehensive literature search of six electronic databases (PubMed-NCBI, Medline-OVID, Embase, Cochrane, Scopus, and Wiley) and secondary search through reference lists was conducted using keywords selected a priori. All primary studies on the use of iris-claw in pediatric ectopia lentis that evaluated visual acuity (VA), complications, and endothelial cell density (ECD) were included and critically appraised using the Newcastle-Ottawa Scale. Ten studies were eligible for inclusion with an overall sample size of 168 eyes of children with ectopia lentis, and the majority of studies evaluated anterior iris-claw IOL. All studies reported improvement in postoperative VA. The most commonly reported complication across studies was IOL decentration. All studies reported decreasing ECD, and this was observed in both anterior and retropupillary iris-claw IOL. Current evidence shows that iris-claw IOL is effective in terms of improving VA in pediatric ectopia lentis. Due to the lack of long-term evidence of its safety in children, one must remain cautious regarding potential endothelial cell loss. Further high-quality, interventional, long-term studies are needed.

Visual Outcomes, Endothelial Loss, and Complications Following Iris-Claw Intraocular Lens Implantation and Trocar-Assisted Sutureless Scleral Fixation of Intraocular Lenses

Visual Outcomes, Endothelial Loss, and Complications Following Iris-Claw Intraocular Lens Implantation and Trocar-Assisted Sutureless Scleral Fixation of Intraocular Lenses

Pars plana lensectomy and iris-claw Artisan intraocular lens implantation in patients with Marfan syndrome.

The rationale of this study was to evaluate the visual and anatomical outcomes of pars plana lensectomy and iris-claw Artisan intraocular lens (IOL) implantation in patients with subluxated crystalline lenses secondary to Marfan syndrome. In this retrospective case series, we evaluate the records of 21 eyes of 15 patients with Marfan syndrome and moderate-to-severe crystalline lens subluxation who underwent pars plana lensectomy/anterior vitrectomy and implantation of iris-claw Artisan IOL at referral hospital from September 2015 to October 2019. Twenty-one eyes of 15 patients (10 males and five females) with a mean age of 24.47 ± 19.14 years were included. Mean best-corrected visual acuity was improved from 1.17 ± 0.55 logMAR to 0.64 ± 0.71 logMAR at the final follow-up visit (P < 0.001). The mean intraocular pressure did not change significantly (P = 0.971). The final refraction showed a mean sphere of 0.54 ± 2.46 D and a mean cylinder of 0.81 ± 1.03 at the mean axis of 57.92 ± 58.33 degrees. One eye developed rhegmatogenous retinal detachment 2 months after surgery. Pars plana lensectomy and iris-claw Artisan IOL implantation seem to be a useful, impressive, and safe procedure with a low rate of complications in Marfan patients with moderate-to-severe crystalline lens subluxation. Visual acuity was significantly improved with acceptable anatomical and refractive outcomes.

Visual Outcomes and Complications of Intraocular Lens Placement in the Absence of Capsular Support in a Philippine Tertiary Hospital.

Surgical correction of aphakia without capsular support continues to be a challenge. Improvements in the technology of cataract surgery have provided advancements in techniques in surgical management of aphakia. Locally, we have limited data on the outcomes of the different intraocular lenses used in aphakia. This study aimed to determine visual outcomes and complications associated with different techniques of intraocular lens implantation in the absence of capsular support. We reviewed the medical charts of 207 patients who underwent intraocular lens implantation without capsular support. Excluded were patients with incomplete follow up, pediatric patients, and lost records. Best corrected visual acuity at day 1, 1st month, 3rd month and 6th month postoperatively, and the complications were noted. Mean age was 60 and 51% (n=105) were females. The mean follow-up time was 9.33 ± 0.71 months. Loss of capsular support was most frequently caused by intraoperative complication (n=146, 70%) and trauma. Retropupillary fixation iris claw intraocular lens was frequently used (n=93, 44.9%). Across all patients, visual acuities showed excellent outcomes with 20/50 or better. Across IOL types, the most frequent postoperative complication was increase in IOP. Statistically significant results were set at P <0.05. There is a notable preference towards iris claw retropupillary lenses through time. Iris claw lenses showed the shortest operative time. All intraocular lenses used in aphakia showed comparably good postoperative visual acuities, except for the superior visual acuity trend seen among retropupillary iris claw and anterior chamber IOL groups. Complications included elevated intraocular pressures, corneal edema, and pigment dispersion.

Visual outcome of intraocular Iris–Claw lens implantation in Indonesian children with ectopia lentis

PURPOSE: The purpose of the study was to describe the visual outcomes of anterior chamber iris–claw intraocular lens (IOL) implantation in pediatric ectopia lentis. MATERIALS AND METHODS: A retrospective review was conducted on the medical records of children with ectopia lentis who underwent primary anterior iris–claw IOL implantation at a national referral hospital in Indonesia in the years 2013–2020. Primary outcomes include visual acuity (VA) and postoperative complications. Postoperative data were collected at 1-year follow-up. RESULTS: A total of 26 eyes of 17 patients were included, the average age at surgery was 9 (5–14) years. Uncorrected VA significantly improved (P = 0.000) from an average of 1.6 ± 0.35 logMAR preoperatively to 0.7 ± 0.33 logMAR postoperatively, best-corrected VA also significantly improved, and 77% of eyes that achieved a postoperative best-corrected VA of 0.3 logMAR. Postoperative complications were reported in three eyes, including elevated intraocular pressure, IOL de-enclavation, severe inflammation, and endophthalmitis; all cases were promptly treated and had good visual outcomes. The mean onset of complications was roughly 3 months (77 ± 129 days) after surgery. CONCLUSION: Anterior iris–claw implantation in children with ectopia lentis appear to be effective in achieving good visual outcome. With its relatively simple technique, anterior iris–claw implantation can potentially serve as a favorable option for the treatment of pediatric ectopia lentis. Long-term prospective research with larger sample sizes is needed.

The role and clinical significance of intraoperative optical coherence tomography for cataract surgery

AbstractPurpose: to evaluate the clinical significance of intraoperative spectral domain optical coherence tomography (iOCT) in cataract surgery with implantation of different types of intraocular lenses (IOL).Methods: In this retrospective observational study, the iOCT image data of 151 cataract cases with different types of implanted IOLs were analysed. For intraoperative imaging a Rescan® 700 was used and the following image criteria were traced: standard surgical steps, IOL optic position, IOL haptic position. Patient eyes were divided into: group 1: n = 101 eyes with lens‐in‐bag (LIB); group 2: n = 15 eyes with bag‐in‐the‐lens IOL (BIL); group 3: 5 eyes with iris‐claw IOL (ICL); group 4: 15 eyes with intrascleral fixated 3‐piece IOL (3‐IOL); group 5: 15 eyes with intrascleral fixated Carlevale IOL (C‐IOL). The data were post‐processed and evaluated statistically.Results: iOCT enabled an additional control of subsequent surgical steps in all studied cases: LIB: the completeness of hydrodissection and hydrodelineation, condition of hydrated paracentesis (in 11% of cases ‐ an incomplete adaptation of paracentesis); BIL: separation of anterior hyaloid and correct implantation of capsular edges into the IOL; ICL: thickness of the iris fold between IOL claws; 3‐IOL/C‐IOL: the position of optic with regard to the iris and position of the haptic in the intrascleral space.Conclusions: The application of iOCT assisted cataract surgery with different IOLs generates useful live data that potentially reduce the risks of intra‐ and postoperative complications (posterior capsule rupture, hypotony, etc.). It can confirm the correct positioning of alternative IOL types intraoperatively, which is crucial to facilitate an optimal IOL performance. The use of iOCT shall be considered during learning process in cataract surgery.

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.

Secondary implantation of retropupillary fixated iris-claw intraocular lenses

There is no standard for the treatment of functional aphakia in cases with acompromised capsular system. Retropupillary fixation of an Artisan iris-claw IOL ("Intraokularlinse") is one of the established procedures. Aim of this study was the evaluation of indications, visual and refractive long-term results and complication rates after retropupillary implantation of an iris-claw lens. This retrospective study comprised 366 eyes that received aretropupillary Artisan intraocular lens (IOL) in asingle center between January 2009 and December 2019. The mean follow-up period was 249 days (8months) ±516 days. IOL dislocation (68%) was the most common reason for aretropupillary iris-claw implantation. Previous vitrectomy was asignificant preoperative risk factor for IOL dislocation (p = 0.0001). Best corrected visual acuity improved from 0.65 ± 0.64 (logMAR) preoperatively to 0.57 ± 0.51 (logMAR) 4-6weeks after the surgery. The mean deviation from the planned refraction was +0.40 ± 1.37 dpt and 73% of the patients had adeviation within ±1 dpt of the planned refraction. Relevant postoperative complications during the first 4 weeks were pupillary distortion (42%), ocular hypotony (15%) and transient hyphema (14%). Late complications (≥4 weeks after the surgery) included persistent pupillary distortion (20%), cystoid macular edema (13%) and iris-claw disenclavation (6%). The retropupillary Artisan implantation is an efficient method for treating aphakia without capsular support and provides good visual and refractive results with an acceptable surgical risk profile.

Comparison of Clinical Outcomes among Conventional Scleral Fixation, Retropupillary Iris-claw Intraocular Lens Implantation, and Intrascleral Fixation.

PurposeTo compare the efficacy and safety of conventional scleral fixation (C-SF), retropupillary iris-claw intraocular lens (RP-IOL) implantation, and intrascleral fixation (ISF).MethodsThis retrospective observational study included 58 patients (58 eyes) who underwent C-SF (23 eyes), RP-IOL (23 eyes), and ISF (12 eyes) by a single surgeon at Samsung Medical Center from October 2017 to July 2020 and were followed up for at least 6 months. This study analyzed various clinical outcomes before surgery, and 1 day, 1 week, 1 month, 3 months, and 6 months after surgery.ResultsSix months after surgery, best-corrected visual acuity in logarithm of minimum angle of resolution was 0.08 ± 0.10, 0.08 ± 0.16, and 0.03 ± 0.04 in C-SF group, RP-IOL group, and ISF group, respectively, and there was a significant improvement in each group compared to preoperative best-corrected visual acuity. All groups showed a significant increase in astigmatism postoperatively, but no between-group differences were observed. The prediction error was −0.15 ± 0.77, 0.56 ± 0.62, and 0.44 ± 1.00 diopters in the three groups, respectively, indicating RP-IOL group and ISF group for hyperopic shift. The three groups did not differ in terms of absolute prediction error. Six months after surgery, the corneal endothelial cell counts were 2,073 ± 691, 2,014 ± 692, and 1,712 ± 891 cells/mm2, respectively, which were lower than before surgery. IOL dislocation occurred in five eyes only in RP-IOL group, two of which underwent two reoperations, and reenclavation was performed smoothly without complications in all cases.ConclusionsAlthough the frequency of IOL dislocation in RP-IOL group was higher than that in the other groups, it can be reenclavated relatively easily. As a method of secondary IOL fixation, both RP-IOL implantation and ISF were as effective as conventional scleral fixation.

A Study of Safety and Efficacy of Use of Iris Claw Lenses in Aphakic Patients

Iris claw lenses have been widely used as a method of secondary intraocular lens implantation. Our study consists of evaluation of safety and efficacy of use of iris claw lenses along with the visual outcome in aphakic patients. A prospective study was carried out on 40 aphakic patients undergoing iris claw lens implantation. Aim of our study was to assess the visual outcome and complications of iris fixated intraocular lens implantation in aphakic patients and the objectives were to study the safety and efficacy of Iris claw intraocular lens, to study the visual outcome in patients undergoing iris claw intraocular lens implantation and the complications associated with it. Thorough evaluation of the patient was done prior to the procedure and it was found that iris claw implantation is a safe, effective and easy method with minimal complications to treat aphakia. The anatomical position of lens is well maintained.

Management of paediatric ectopia lentis at an Indonesian referral hospital: A retrospective review

Background: Ectopia lentis in children is rare and often associated with systemic conditions. Left untreated, it can lead to visually debilitating complications. Although there are various techniques available, no current consensus for treatment of paediatric ectopia lentis exists.Aim: To describe the management and visual outcomes of paediatric ectopia lentis in an academic referral hospital.Setting: This study was conducted at Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia.Methods: A retrospective review was conducted on the medical records of all paediatric ectopia lentis patients treated at our hospital, from 2011 to 2020. Primary outcomes include uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), treatment, surgical technique, selection of intraocular lens (IOL), and postoperative complications.Results: This study included 66 eyes of 39 patients. Average age at initial presentation was 7.8 (2–17) years. Aetiology was mostly non-traumatic, whilst four were secondary to trauma. All eyes except one underwent surgery, and IOLs were inserted in 57.4% of the non-traumatic cohort, with iris-claw IOL as the most popular choice (85.7%). Uncorrected visual acuity and BCVA significantly improved in pseudophakic and aphakic groups (p 0.05). Nearly 60% achieved a BCVA of 6/12 or greater, and the proportion was higher amongst pseudophakic group. Ten eyes had post-operative complications, with a median onset of 393 (1–1095) days after surgery.Conclusion: With varied techniques used to manage paediatric ectopia lentis, the choice of technique was dependent on individual patient condition and surgeon preference. Whilst the proportion of eyes with BCVA of ≥ 6/12 was higher amongst the pseudophakic eyes than aphakic eyes, IOL implantation entails the risk of complications, whereas no complications occurred in those left aphakic. Therefore, no particular technique can be considered marginally superior to the other, and larger studies are needed.

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.

An unusual complication of retropupillary iris claw intraocular lens fixation

A patient with well enclaved retropupillary iris-claw intraocular lens (IOL) presented 3 months later with spontaneous diminishing of vision to counting fingers at 3 m. On slit-lamp examination, the cornea was clear, the anterior chamber was normal in depth and the IOL was found to have rotated by 90° and was now vertical, perpendicular to the iris and pupillary plane, and the superior site of enclavation was kinked. The edge of the IOL optic was seen protruding out of the pupil; however, not touching the cornea and a fibrosed posterior capsule was noted nasally. The patient was taken for anterior vitrectomy with repositioning of the IOL. The lever effect of the remnant posterior capsule can be the cause of the tilt.

Tilt and decentration of posterior and anterior iris-claw intraocular lenses: a pilot study using anterior segment optical coherence tomography

BackgroundInformation on the centration and tilt of iris-claw intraocular lenses (IC-IOLs) is limited. In this study, we tested the capacity of an anterior segment optical coherence tomography (AS-OCT) instrument to measure decentration and tilt of anterior and posterior IC-IOLs through an integrated software.MethodsThe present observational, cross-sectional study was conducted at University Eye Clinic of Parma (Parma, Italy). The CASIA2 swept-source AS-OCT (Tomey Corp.) was used to measure the tilt and decentration of posterior and anterior IC-IOLs in patients implanted at least 6 months in advance. After failure with full-automation, semi-manual IOL tracing was applied. In-the-bag (IB) contralateral IOLs, when present, were measured automatically. The Bland-Altman method was used to evaluate the agreement between repeated measurements (2 images for each study eye). The amount and direction of tilt and decentration were recorded and plotted into polar charts for evaluation.ResultsA total of 21 patients were included: 14 with posterior and 7 with anterior IC-IOL fixation. In 17 eyes (81%), the AS-OCT provided a repeatable measurement of tilt and decentration. All contralateral eyes with IB IOL were automatically measured. The median decentration was 0.67 mm, 0.24 mm, and 0.24 mm in posterior IC-IOLs, anterior IC-IOLs, and IB IOLs group, respectively. The median tilt was 5.0°, 5.6°, and 5.6° for posterior IC-IOLs, anterior IC-IOLs, and IB IOLs, respectively. Tilt direction was mainly temporal, while decentration was inferior-temporal with posterior IC-IOLs and scattered with anterior IC-IOLs and IB IOLs.ConclusionsThe semi-manual tracing function of the CASIA2 AS-OCT provides repeatable and affordable measurements of the decentration and tilt of IC-IOLs in both the anterior and posterior chamber. Data from the former group were similar to the IB group.

Visual Acuity and Complications After Secondary Retropupillary Iris-Claw Intraocular Lens Implantation at Undaan Eye Hospital Surabaya in 2019 - 2020

Introduction : Intraocular lens implantation is a treatment of choice in cases of aphakia. Aphakia conditions with minimal or no capsular support can use the anterior chamber LIO technique, iris, sulcus, and scleral fixation. The retropupillary iris fixation technique is an alternative technique that is often chosen by operators in aphakia caused by minimal complications and good visual outcomes. Purpose: to describe visual acuity and complication after secondary iris claw retropupillary intraocular lens implantation in patients with aphakia. Method: this research was a descriptive study by taken data from medical records at Undaan Eye Hospital Surabaya on January 2019 to Desember 2020. We observed the outcome visual acuity and complication from first day until 3 months after surgery. The population in this study was all aphakia patients who had secondary retropupillary iris-claw IOLs implantation surgery that fulfilled the inclusion criterias. Results: This study found that from 19 subjects, dominated by male (57,90%). The age group consisted of 49-76 years old, mean 59,05 years old. The most common cause of aphakia was lens subluxation (78.94%) as a result of previous cataract surgery. The complication found was a surgical induced astigmatism (52.63%).

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.

Correction: Simultaneous Management of Retinal Detachment and Aphakia with Pars Plana Vitrectomy, Silicone Oil Tamponade and Retropupillary Iris-Claw Intraocular Lens Implantation in Patients with Marfan Syndrome.

Correction to: Simultaneous Management of Retinal Detachment and Aphakia with Pars Plana Vitrectomy, Silicone Oil Tamponade and Retropupillary Iris-Claw Intraocular Lens Implantation in Patients with Marfan SyndromeKlin Monbl Augenheilkd 2022; 239(04): 490-493DOI: 10.1055/a-1766-6381

Surgical outcome of retropupillary iris-claw lens implantation: a retrospective review

Introduction: Intraocular lens (IOL) selection, especially in cases with insufficient capsular and/or zonular support has increasingly become a challenge to surgeons. Retropupillary iris-claw IOLs (RP-ICIOL) have gained popularity in recent years.Purpose: This study aimed to review the outcomes of RP-ICIOL implantation in two tertiary eye centres.Study design: Retrospective review.Methods: This is a retrospective study of 14 eyes of 14 patients who underwent Artisan RP-ICIOL implantation between November 2018 and December 2020 in two tertiary eye centres in Malaysia.Results: The mean age of patients was 51.5 ± 17.4 years with the range between 18 and 77 years old. There were ten (71.4%) males and four (28.6%) females. The IOL was implanted primarily in three eyes (21.43%) and as a secondary procedure in eleven eyes (78.6%). Mean preoperative best-corrected visual acuity (BCVA) was logMAR 1.32 ± 0.82, while mean postoperative BCVA was logMAR 0.56 ± 0.42 (p = 0.010). Visual improvement of two or more lines in BCVA was observed in nine eyes (64.3%), no improvement in two eyes (14.3%), and worsening in three eyes (21.4%). There were no complications observed during the surgery. All our patients had a well-centred IOL at the 1-month postoperative follow-up. Mean preoperative intraocular pressure was 16.8 ± 2.0 mmHg and postoperative intraocular pressure was 15.7 ± 5.1 mmHg (p = 0.430).Conclusion: RP-ICIOL implantation is safe and provides the optical advantage of a more biologically appropriate retropupillary position, ensuring a favourable functional visual outcome with low risk of complications.

Visual and refractive outcomes following secondary intraocular lens implantation

ABSTRACT Purpose To analyze the visual and refractive results after secondary IOL implantation using different surgical techniques - iris-claw aphakic IOL through a corneal incision or scleral tunnel, and 3-piece IOL into the ciliary sulcus. Patients and methods Retrospective study including patients that were submitted to secondary IOL implantation from January 2017 to December 2019 at the Department of Ophthalmology of Hospital de Braga, Portugal. We collected demographic data (age, surgical indication, comorbidities, surgical technique, IOL implanted, and intra and postoperative complications) and visual and refractive data [preoperative and 3-month, 6-month, and 12-month postoperative corrected-distance visual acuity (CDVA), spherical equivalent (SE), manifest cylinder, and intraocular pressure]. Results 128 eyes from 123 patients were included. The most frequent surgical indications were IOL subluxation/luxation (62.5%) and intraoperative posterior capsular rupture (23.4%). CDVA improved from 1.26 ± 0.51 to 0.47 ± 0.49 logMar (p < .001). CDVA was significantly better in the 3-piece into the ciliary sulcus IOL group than both other groups. The final SE was −0.68 ± 0.94 diopters. The mean manifest refractive cylinder remained stable until the 6th month after the surgery (p = .454) and improved in the last 6 months of follow-up (p = .015). In the postoperative period, the cylinder was higher in the corneal incision iris-claw aphakic IOL group and lower in the 3-piece IOL into the ciliary sulcus group (p < 0,05). The corneal incision iris-claw aphakic IOL group presented the most postoperative complications. Conclusion All techniques showed satisfying results. The 3-piece IOL into the ciliary sulcus group showed the best visual and refractive performance, followed by the scleral tunnel iris-claw IOL group and the corneal incision iris-claw IOL group.

OUTCOMES OF RETROPUPILLARY IRIS CLAW INTRAOCULAR LENS IMPLANTATION COMBINED WITH PARS PLANA VITRECTOMY.

To report 12-month visual outcomes, incidence of intraocular pressure (IOP) changes and postoperative complications after pars plana vitrectomy with retropupillary implantation of an iris claw intraocular lens (IOL) in aphakic eyes after complicated cataract surgery and eyes with a dislocation of the IOL. This is a retrospective analysis of eyes undergoing implantation of an iris claw IOL combined with pars plana vitrectomy from 1st of January 2009 until 30th of June 2018 after complicated cataract extraction with capsular loss (Group A) or dislocation of an IOL (Group B). Corrected distance visual acuity was analyzed in logarithm of the minimum angle of resolution (logMAR) units, IOP was recorded in mmHg. Eyes in Group A (n = 49) improved from a preoperative median visual acuity of 0.523 logMAR (Snellen 20/65) to 0.201 logMAR (Snellen 20/30), P < 0.01. Eyes in Group B (n = 126) showed stable median visual acuity, preoperative 0.301 logMAR (Snellen 20/40) versus postoperative 0.222 logMAR (Snellen 20/30), P > 0.05. During 12 months in Group A, IOP >21 mmHg occurred in 9 (18.4%) eyes; no eye had an IOP <6 mmHg. In Group B, IOP >21 mmHg occurred in 15 (11.9%) eyes, IOP <6 mmHg in 5 (4%) cases. None of the eyes in Group A and B had IOP >21 mmHg or <6 mmHg at 12 months follow-up. The retropupillary implantation of an iris claw IOL with pars plana vitrectomy provides adequate visual rehabilitation and seems to be safe in IOP changes.