Retropupillary Iris-Claw Intraocular Lens Implantation: A Refractive and Safety Report
DOI:
https://doi.org/10.48560/rspo.28782Keywords:
Aphakia, Cataract Extraction, Lens, Crystalline, Lenses, IntraocularAbstract
INTRODUCTION: Iris-claw intraocular lenses are one of the surgical alternatives to treat patients without capsular and zonular support after complicated cataract surgery, trauma, or diseases that disrupt the normal anatomy of the eye’s posterior chamber. Retropupillary fixation, through the enclavation of the lens to the posterior iris, constitutes a modification of the original technique, and is associated with fewer long-term complications, particularly regarding the loss of corneal endothelial cells. The purpose of this study was to evaluate the visual and refractive results and to report the associated complications of patients who underwent retropupillary implantation of the Artisan Aphakia IOL® (Ophtec).
METHODS: A retrospective, observational, single-center study of consecutive eyes, including 26 patients who underwent surgery in Hospital Pedro Hispano, between 2012 and 2021. The outcome measures consisted of postoperative best-corrected visual acuity, spherical equivalent, intraocular pressure, and complications.
RESULTS: The most common indication for surgery was previous complicated cataract surgery (50%), followed by trauma (26.9%) and spontaneous intraocular lens luxation (11.5%). The mean best-corrected visual acuity was 0.52 ± 0.62 logMAR and the mean spherical equivalent was 0.075 ± 1.46 diopters. Postoperative ocular hypertension occurred in 7.7% of the patients. The most common complication was the luxation of one of the haptics of the lens, which happened to 19.2%of patients. Cystoid macular edema was present in 11.5% of the patients.
CONCLUSION: Retropupillary iris-claw intraocular lens implantation is a valid alternative for treating aphakia in the absence of capsular support. It is a safe technique, with decent functional outcomes. Most long-term complications are related to the status of the eye before surgery, as it is often performed in complex patients, with important comorbidities, and that should be con- sidered regarding the expected final outcome. Alternatives such as scleral fixation of intraocularlenses may provide a more predictable refractive outcome but are technically harder and depend on the surgeon’s experience. The surgical technique should be individualized according to the characteristics of the patient, and the preference and experience of the surgeon.
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