[Retropupillary fixation of the iris claw lens in aphakia. 1 year outcome of a new implantation techniques]

Light- and drug-induced pupillary dynamics in eyes with a retropupillary iris-claw intraocular lens

PURPOSE

We evaluated the pupillary characteristics and response to light and drugs in eyes with posterior chamber (PC) placement of iris-claw intraocular lens (IC-IOL).

METHODS

In this cross-sectional, comparative study, we included adults with an IC-IOL implanted in the PC of a single eye. We excluded patients with ocular trauma, postoperative IC-IOL displacement or complications, and extended iris atrophy. We used anterior segment optical coherence tomography to perform light-controlled pupillography, measure the pupil diameter (PD), and estimated the pupil circularity under mesopic conditions. PD was also assessed under photopic, scotopic, pharmacological mydriasis, and miosis conditions. The results were compared to those of the fellow eye, phakic, or regular pseudophakic.

RESULTS

The IC-IOL and control groups included 30 eyes each. The most frequent reasons for IC-IOL implantation were complicated cataract (37%) and dislocated/luxated prior IOL (33%). Compared to the control group, the IC-IOL group had lower visual acuity, a smaller PD under scotopic conditions (p = 0.0010) and after pharmacological mydriasis (p < 0.0001), and a larger PD after pharmacological miosis (p < 0.0001). Mesopic pupil circularity was comparable between the groups. We also considered ongoing extraocular treatments with possible effects on iris motility.

CONCLUSIONS

The pupillary size and profile were similar between the groups in mesopic light. Reduced mydriasis was noted in response to light and drugs, while the degree of miosis was reduced in response to inducing drugs in the IC-IOL compared to the control group. This study complements previous results concerning the PC placement of IC-IOLs by adding original observations on drug-induced pupil motility.

[Secondary implantation of retropupillary fixated iris-claw intraocular lenses]

BACKGROUND

There is no standard for the treatment of functional aphakia in cases with a compromised capsular system. Retropupillary fixation of an Artisan iris-claw IOL ("Intraokularlinse") is one of the established procedures.

OBJECTIVE

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.

MATERIAL AND METHODS

This retrospective study comprised 366 eyes that received a retropupillary Artisan intraocular lens (IOL) in a single center between January 2009 and December 2019. The mean follow-up period was 249 days (8 months) ±516 days.

RESULTS

IOL dislocation (68%) was the most common reason for a retropupillary iris-claw implantation. Previous vitrectomy was a significant 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) 4-6 weeks after the surgery. The mean deviation from the planned refraction was +0.40 ± 1.37 dpt and 73% of the patients had a deviation 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%).

CONCLUSION

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.

The influence of the Artisan-Verisyse position on the postoperative outcomes: A systematic review and meta-analysis

Iris-fixated intraocular lens (IOL) is considered a safe and effective option for the correction of aphakia in patients with insufficient capsular support. This systematic review aims to summarize the existing evidence about the Artisan/Verisyse IOLs and to assess the influence of the IOL position on the postoperative outcomes. Three different databases were used for this systematic review and metaanalysis (PubMED, Scopus, and Embase). We searched for case series or clinical trials comparing the prepupillary versus retropupillary Artisan/Verisyse implantation. The statistical analysis was performed with the programming language R (version 3.6.1 2019-07-05). The number of articles included in the meta-analysis was six, with 506 eyes included in total. We found no significant differences in postoperative corrected distance visual acuity (CDVA) (0.309 [0.089-0.528] vs. 0.32 [0.2-0.44]), spherical equivalent (SE) (0.0153 D [-0.362 to 0.393] vs. -0.329 D [-0.62 to - 0.038]), and central corneal cell density (CECD) (1669.85 cells [1605.949-2150.937] vs. 1635.99 cells [1413.64-1858.363]) between the prepupillary and the retropupillary implantation, respectively. There were no significant differences in the rates of cystoid macular edema (CME; 7.70% vs. 9.8%), pupil deformation (4.5% vs. 5.4% retropupillary), or IOL luxation (2.3% and 2.2%). We found little influence of the IOL position in the postoperative analyzed outcomes. Thus, the implant position should be based on the surgeon's technical experience. Double-blind randomized prospective studies would improve the available evidence on the best implant position for the Artisan/Verisyse IOL.

Optical Coherence Tomography Position Analysis of Retropupillary Iris-Fixated Intraocular Lens in Iris Tissue

Purpose

The aim of this study was to evaluate a micrometer-accurate analysis of the retropupillary Verisyse® intraocular lens (IOL) (Ophtec, Groningen NL; Santa Ana, USA) enclavation in the iris tissue.

Methods

A retrospective consecutive case series was conducted at the Department of Ophthalmology, University Hospital Mainz. Patients with an optical coherence tomography (Spectralis®, Heidelberg Engineering®; Heidelberg, Germany) examination after retropupillary Verisyse® IOL implantation were included retrospectively. The enclavation geometry was measured using the Eye-Explorer® from Heidelberg Engineering® (Heidelberg, Germany). Seventeen measuring positions were determined nasally and temporally at the corresponding enclavation points.

Results

72 eyes of 67 patients after implantation of a retropupillary Verisyse® IOL were analyzed. The average age was 68 ± 17.2 years (63% female; 38% male). The analysis of the position of the Verisyse® IOL showed highly homogeneous data in all measured points. The depth of the anterior chamber showed a positive correlation with width of the posterior deflection of the iris tissue behind the enclavation (Pearson r: 0.321, p=0.041). The offset of the haptics showed greater deviations, and the lens diopter implanted was higher (r = 0.337, p=0.007).

Conclusion

This is the first study that analysis the exact enclavation of retropupillary implanted Verisyse® IOL. It provides new information about the intrastromal course of the haptics in the iris tissue. It could be shown that the haptics do not run parallel in the iris tissue, but are anchored in the iris tissue with an average offset of 95 µm. This rebuts previous assumptions about the intrastromal course and provides new information.

Implantation of retropupillary iris-claw lenses: A review on surgical management and outcomes

Iris-claw lenses have gained increasing popularity over the last years and are by many surgeons regarded as viable options in eyes with insufficient capsular or zonular support. The iris-claw lens has two haptics with fine fissures for folding (enclavating) the mid-peripheral part of the iris stroma and can either be placed in front of or posterior to the iris. In particular, the retropupillary implantation has been increasingly chosen probably due to having an anatomical position similar to that of the crystalline lens. The present review is based on a literature review and also on the authors' clinical experience with this lens, and it focuses on surgical techniques and outcomes especially related to the characteristics of this lens, having haptics with claws that fixate the lens to the posterior iris. Implanting retropupillary iris-claw lenses has a relatively short learning curve, and there are only few complications reported during surgery. Retropupillary iris-claw lenses have demonstrated generally favourable efficiency and safety. However, the outcomes are probably more influenced by the reason for surgery and eye comorbidity than the lens itself. Albeit seldom reported, the postoperative complications have mostly been related to atrophy of the iris at the site of the haptics, or IOL decentration or disenclavation of one of the haptics. To date, however, there are few randomized clinical trials comparing this lens to other lens alternatives in eyes exhibiting insufficient capsular or zonular support for placing the lens in the ciliary sulcus. In the future, prospective studies with large samples should be performed to gain insights into the long-term safety of retropupillary placed iris-claw lenses, and for comparisons with the various other techniques of lens fixation.

Pupil dynamics after in-the-bag versus anterior and retropupillary iris-fixated intraocular lens implantation

An Intraocular Lens (IOL) fixated on the iris either anteriorly, as a phakic IOL, or posteriorly, as an aphakic IOL, can influence pupil motility. In this interventional case series study, we evaluated pupil size under different levels of illumination (scotopic = 0.04 lx, low-mesopic = 0.4 lx and high-mesopic = 4 lx) for anterior iris-claw IOL fixation for correcting myopia or hyperopia (IFPH), retropupillary iris-claw IOL fixation to correct aphakia or as treatment for late in-the-bag IOL dislocation/subluxation (IFRP), and capsular-fixation IOL in-the-bag implantation (IB). Pupil size was measured preoperatively for the IFPH- and IB-group as well as 6 months after surgery for all groups. We analyzed a total of 70 eyes: 22 eyes of 11 patients with phakic IOLs, 22 eyes of 20 patients in the IFRP group and 26 eyes of 13 patients in the IB group. Both IFPH and IB showed a smaller postoperative scotopic pupil size, compared with the preoperative values. When compared to postoperative values of IB and IFPH, IFRP showed a significantly smaller postoperative scotopic pupil size (IFPH: 5.89 ± 0.83 mm, IFRP: 4.37 ± 0.83 mm, IB: 5.34 ± 0.98 mm, p < 0.001) while no differences were seen at high-mesopic lighting. Neither of the surgical techniques seems to impair the constriction of the pupil.

RETROPUPILLARY IRIS-CLAW INTRAOCULAR LENS AND PARS PLANA VITRECTOMY IN APHAKIA MANAGEMENT: A National Multicenter Audit

PURPOSE

To evaluate the outcomes and safety of retropupillary iris-claw intraocular lens implantation and associated pars plana vitrectomy.

METHODS

Multicenter, national audit of 325 eyes (325 patients). Demographics, surgical details, and complications are described. Visual acuity, intraocular pressure, and central retinal thickness assessed by optical coherence tomography were collected at 1, 3, 6, and 12 months after surgery. Kaplan-Meier curves were created to assess the cumulative probability of postoperative visual acuity and intraocular pressure levels, macular edema development, and corneal decompensation.

RESULTS

The cumulative probability of the final visual acuity ≤0.3 logarithm of the minimum angle of resolution (≥20/40 Snellen) was 75.6% at 12-month follow-up. The probability of intraocular pressure >21, ≥25, and ≥30 mmHg was 48.1%, 33.1%, and 19.0%, and the probability of intraocular pressure-lowering drops was 50.9% at 12 months. Glaucoma surgery was required in 4.3% of the eyes (14/325). The cumulative probability of macular edema was 20.5% at 12 months and was greater in complicated cataract surgery than in intraocular lens-luxation eyes (26% vs. 16.7%, P = 0.04). Corneal transplantation was required in 2.8% of the eyes (9/325).

CONCLUSION

This study on 325 eyes with aphakia or intraocular lens dislocation managed with the retropupillary iris-claw intraocular lens technique provides clinical outcomes in a real-world scenario, reporting relevant data for patient counseling and preoperative discussions.

Refractive Outcomes of Retropupillary Fixated Iris-Claw Lens for Exchange of the Dislocated Intraocular Lens Using Modified Scleral Incisions

Purpose

To evaluate refractive outcomes after retropupillary iris-claw intraocular lens (IOL) implantation and to compare postoperative astigmatism from (1) a conventional 5.5-mm sclerocorneal incision, (2) an L-shaped scleral tunnel incision, and (3) a frown scleral tunnel incision.

Methods

This was a retrospective study of eyes undergoing dislocated IOL exchange for a retropupillary iris-claw IOL. Uncorrected and corrected distance visual acuity (UDVA and CDVA) and postoperative complications were evaluated until postoperative months 24. The refractive outcomes and the surgically induced astigmatism (SIA) vector were compared between groups.

Results

The medical records of 107 eyes from 107 patients with mean age of 65.31 ± 12.15 years were reviewed. Eyes with a frown incision showed the best UDVA, followed by those with L-shaped and conventional incisions (P = 0.003). Eyes with an L-shaped incision or frown incision had a lower SIA than that of the conventional incision group at postoperative 6 months (mean ± standard deviation [SD] SIA, 0.86 ± 0.85 D, 0.63 ± 0.37 D, and 1.70 ± 1.27 D for frown incision, L-shaped incision, and conventional incisions, respectively; P = 0.004).

Conclusion

The frown incision and L-shaped incision induced a significantly smaller SIA than the conventional incisions, which was associated with better UDVA postoperatively.

Comparison of decentration, tilt and lenticular astigmatism of ıntraocular lens between sutured and sutureless scleral fixation techniques

PURPOSE

To evaluate at six months the intraocular lens (IOL) decentration, tilt and lenticular astigmatism between foldable sutured and sutureless scleral fixation IOLs compared to conventional phacoemulsification surgery.

METHODS

We retrospectively reviewed records for 22 eyes with sutureless scleral fixation, 16 eyes with sutured scleral fixation and 23 eyes with conventional phacoemulsification. IOL decentration and angle of IOL tilt were compared on Scheimpflug images 6 months after surgery. Lenticular astigmatism is described as the difference between refractive and net corneal astigmatism.

RESULTS

The angle of tilt in both meridians was significantly lower in the sutureless group than in the sutured group (P=0.008 horizontally and P=0.002 vertically). IOL decentration did not show a significant difference between the three groups in either horizontal or vertical meridians (P˃0.05). Lenticular astigmatism was significantly lower in the sutureless and control groups than in the sutured group (P=0.003 and P<0.001).

CONCLUSION

In addition to being relatively quick and easy to perform, the sutureless scleral fixation technique showed superior results in terms of IOL tilt and lenticular astigmatism at the six-month follow-up compared to the sutured technique.

Retropupillary Iris-Claw Intraocular Lenses: A Literature Review

Retropupillary iris-claw intraocular lenses (ICIOLs) have been increasingly chosen by surgeons nowadays as a primary or secondary procedure of IOL implantation in eyes with insufficient capsular or zonular support. They have gained popularity due to their simple fast technique, favourable functional outcomes, and safety. The transition in the ICIOL fixation from prepupillary to a more biologically appropriate retropupillary position and change in the optic design from biconvex to convex-concave have provided better visual outcomes and improved safety. A peer-reviewed literature search was conducted in Medline (PubMed), Embase, and Cochrane Library using the keywords "retropupillary iris claw" and "iris claw". The search yielded 310 articles that were screened. Forty-three articles on retropupillary ICIOLs were finally found to be relevant and reviewed in full-text versions. The functional outcomes following retropupillary implantation of ICIOLs have been acceptable in eyes with no ocular co-morbidities otherwise. However, the indications for surgery may affect the outcomes. The major postoperative complications directly associated with ICIOLs include pupil ovalization and redislocation. Nevertheless, the rate of disenclavation depends on the experience and skill of the surgeon. This review is based on a literature review, and it focuses on the preoperative evaluation, surgical technique, postoperative outcomes, and associated complications. Prospective randomized trials with a larger sample size and longer follow-up are needed for comparison with other techniques of IOL fixation and confirmation of long-term safety profile.

Comparison of retropupillary fixated iris claw lens versus sclera fixated lens for correction of pediatric aphakia secondary to ectopia lentis

AIM:

To evaluate the postoperative visual acuity and complications in eyes with ectopia lentis in children who underwent lens removal and then implantation of retropupillary fixated iris claw lens versus scleral fixated intraocular lens (SFIOL) implantation.

MATERIALS AND METHODS:

A retrospective analysis of pediatric cases who presented with lens subluxation secondary to ectopia lentis and who underwent lens extraction (57 eyes of 38 patients) with either retropupillary iris fixated intraocular lens (IOL) implantation (Group A – 36 eyes of 20 patients) and SFIOL implantation (Group B – 21 eyes of 18 patients) was done over a period of 5 years from March 2010 to February 2015. The main outcome measures were preoperative and postoperative best-corrected visual acuity (BCVA) and secondary postoperative complications.

RESULTS:

The study patients were divided into two groups: Group A patients were implanted with retropupillary iris claw lens whereas Group B patients were implanted with SFIOL. The mean age of presentation was 12 years, the mean follow-up period was of 24 months (range 14–36 months), and the median follow-up period was 26 months in both the groups. An improvement in the mean BCVA (LogMAR) was seen in both the groups. In Group A, the mean BCVA improved from 1.5 ± 0.2 preoperatively to 0.3 ± 0.2 postoperatively, whereas in Group B, the mean BCVA improved from 1.5 ± 0.3 preoperatively to 0.3 ± 0.2 postoperatively (P < 0.001). None of the eyes in either of the groups had any serious complications such as glaucoma, uveitis, cystoid macular edema, or endophthalmitis.

CONCLUSION:

Retropupillary iris fixation and scleral fixation of IOL are both safe and viable options for the correction of ectopia lentis in pediatric age group.

Via pars plana anterior iris enclavation IOL fixation

AIM

To describe a via pars plana anterior iris enclavation intraocular lens (IOL) fixation technique.

METHODS

A total of 35 consecutive aphakic vitrectomised patients (average age 71.12±10.12y) underwent pars plana vitrectomy (PPV) and via pars plana anterior iris enclavation IOL fixation.

RESULTS

The mean preoperative best corrected visual acuity (BCVA) was 0.11±0.14 logMAR, the mean postoperative BCVA was 0.07±0.11 logMAR. The preoperative mean spherical equivalent was 7.22±4.21 D. The final mean spherical equivalent was -0.25±0.15 D. No eyes had hypotony, retinal or choroidal detachment or endophthalmitis.

CONCLUSION

This technique may be a safe and useful in the case of aphakia, and a prospective study would be useful to confirm this findings.

Long-term surgical outcomes of primary retropupillary iris claw intraocular lens implantation for the treatment of intraocular lens dislocation

We aimed to investigate the efficacy and safety of primary retropupillary iris claw intraocular lens (R-IOL) implantation in patients with complete intraocular lens (IOL) dislocation. In this single-center retrospective case series, we reviewed the medical records of patients who underwent R-IOL implantation surgery with pars plana vitrectomy for the treatment of IOL dislocation between September 2014 and July 2019. The primary outcome was change in visual acuity (VA) up to 24 months postoperatively. The secondary outcomes included changes in intraocular pressure (IOP), refractive errors, and endothelial cell count (ECC) over the same period. Data of 103 eyes (98 patients) were analyzed. The mean uncorrected VA was significantly improved at one month postoperatively (− 0.69 logMAR, P < 0.001), compared to the preoperative value. IOP (− 2.3 mmHg, P = 0.008) and ECC (− 333.4 cells/mm², P = 0.027) significantly decreased one month post-surgery and remained stable thereafter. Postoperative mean spherical equivalents were similar to the prediction error throughout the follow-up period. IOP elevation (n = 8, 7.8%), cystoid macular edema (n = 4, 3.9%), and dislocation of the R-IOL (n = 10, 9.7%) were managed successfully. Overall, primary R-IOL implantation with pars plana vitrectomy is effective and safe for correcting IOL dislocation due to various causes.

The forceps-needle: Combining needle and grasping functions in a single instrument

A new forceps-needle to facilitate intrascleral haptic fixation surgery is described. In an initial series of 10 cases, the forceps-needle was used to grasp and externalize the haptic of a 3-piece intraocular lens (IOL) for transscleral fixation. The site of perforation was marked at 180 degrees 2.0 mm away from the limbus. Then, the IOL with polypropylene haptics was folded and implanted partially into the anterior chamber. A transconjunctival, scleral tunnel of about 2.0 mm length parallel to the limbus was prepared with the forceps-needle on 1 side, with the second hand holding the leading haptic through a side-port incision. The end of the first haptic was grasped and externalized after which the end of the haptic was flanged. Subsequently, a second scleral tunnel was prepared with the forceps-needle, and the second haptic was externalized and flanged. All procedures could be performed without any intraoperative complication.

Re-Enclavation of a Dislocated Retropupillary Fixated Iris Claw Lens: A Case Report

A male patient, 63 years of age, presented with dislocation of a retropupillary fixated iris claw lens due to nasal haptic disenclavation. During re-enclavation the intraocular lens dislocated again. To avoid further dislocation, both superior fingers of the haptics were pushed through the iris tissue to achieve more stable support of the haptic ends. This method of fixation appeared to be well tolerated.

[Morphofunctional changes and complications after out-of-the-bag intraocular lens implantation]

The article reviews morphofunctional changes and complications after using modern methods of out-of-the-bag implantation of the intraocular lens (IOL). Literature data shows that the smallest morphofunctional changes in intraocular structures and the best results are obtained after retropupillary implantation of an iris-claw lens and transscleral fixation of posterior chamber IOL.

[Methods of out-of-the-bag intraocular lens implantation]

The article reviews the main modern methods of out-of-the-bag IOL implantation. Literature data shows that the most pressing question to date is comparative assessment of retropupillary iris-claw lens implantation and trans-scleral posterior chamber IOL fixation.

[Long term postural myopic shift assessment after posterior iris-claw aphakic intraocular lens implantation]

PURPOSE

Posterior chamber iris-claw intraocular lens (IOL) is often used in aphakic eyes with inadequate capsular support. Postoperatively, patients may describe better capabilities for near reading in a face-down position. The goal was to evaluate the indications, visual outcomes and complications of this IOL and to compare postoperative spherical equivalent between the prone and the face-down position.

MATERIALS AND METHODS

Retrospective single-center case series of 31 eyes of 28 patients who underwent surgery between 2007 and 2016. Visual outcomes, early and late complications were analyzed. The refractive measurements were also assessed using a portable refractometer in prone and face-down position for each patient. The spherical equivalents were then compared.

RESULTS

The mean follow up was 29 months (3-73). The final mean corrected visual acuity (0.17±0.5 SD LogMar) was significantly better than preoperatively (0.5±0.50 SD LogMar) (P<0.05). Postoperative refractive error was within±2 diopters of emmetropia in 95 % of patients. The mean spherical equivalents in prone and face down position were different (P<0.05),-0.44 diopters (-4;+2.75) and-1.38 diopters (-5.25; 1) respectively. A mean myopic shift of-0.95 diopters (-5.25; 1.00) was observed in face down position. Cystoïd macular edema (6 %) and IOL disenclavation (9.6 %) were the main complications.

DISCUSSION

A posterior iris-claw intraocular lens appears to be an effective and relatively safe IOL to treat aphakia with poor capsular support. When the patient's head is bent forward, a mean myopic shift of 1 diopter is observed. This may support the idea that this IOL could be considered as an accommodative implant. Anterior movement of the iris-IOL complex due to gravity may be responsible for this myopic shift.

Outcomes of intraocular lens scleral fixation with the friction knot technique

PURPOSE

To examine the clinical outcomes of intraocular lens (IOL) scleral fixation with the friction knot technique.

METHODS

Retrospective case series of 152 eyes of 152 patients with inadequate capsular bag support operated with the friction knot IOL scleral fixation technique by a single surgeon. The fixated IOLs were one-piece or three-piece models all with open loop haptics. Main outcome measures were change in corrected distance visual acuity (CDVA) and postoperative complications.

RESULTS

The mean follow-up time was 11.7 months (median 4.9, range 0.7-64.8). The mean logarithm of the minimum angle of resolution CDVA improved from preoperative 0.77 ± 0.73 (Snellen 20/118 ± 7.3 lines) to 0.44 ± 0.56 (Snellen 20/55 ± 5.6 lines) at the final visit (p < 0.001). The main postoperative complications were ocular hypertension (30.3%), uveitis-glaucoma-hyphaema syndrome (12.5%; UGHS), vitreous haemorrhage (11.2%) and retinal detachment (8.6%). Two (1.3%) cases of suture breakage were seen. In multivariate Cox regression analysis, age under 60 years [hazard ratio (HR) = 5.41; 95% confidence interval (CI) 1.95-15.01] and scleral fixated one-piece IOL (HR = 4.23; 95% CI 1.44-12.44) were found as significant independent risk factors for developing new UGHS.

CONCLUSION

The friction knot technique provides a firm scleral fixation. Scleral fixation may successfully be utilized in dislocated three-piece IOLs with loop haptics. We recommend avoiding scleral fixation of one-piece IOLs in young patients due to a high risk of UGHS.

Five-year follow-up of secondary iris-claw intraocular lens implantation for the treatment of aphakia: Anterior chamber versus retropupillary implantation

BACKGROUND

Though several procedures of IOL implantation have been described (sutured scleral fixation, intra-scleral fixation, angle-supported anterior chamber, and anterior chamber or retropupillary iris-claw IOLs), there are no randomized trials which are comparing different techniques. Hence, the surgical treatment of aphakia still remains controversial and challenging. The purpose of this study was to compare the long-term efficacy and the rate of complications of anterior versus posterior Iris-claw intraocular lenses (IOL) implantation to correct for the treatment of aphakia without sufficient capsule support.

METHODS AND FINDINGS

Consecutive eyes having secondary implantation of aphakic iris-fixated IOLs with a follow-up of at least 5 years were considered. Mean correct distance visual acuity (CDVA) changes, percentage of eyes with CDVA improvement, mean corneal endothelial cell density (CECD) loss and the rate of other complications were used for statistical analysis. The study evaluated a total of 180 eyes (Group A: 87 anterior chamber iris-claw fixation, Group B: 93 retropupillary iris-claw implantation) of 180 consecutive different patients, with aphakia of various reasons. CDVA improved significantly in both groups after surgery (P<0.001, ANOVA), and was remarkably higher than baseline in both groups from first week and during the entire follow-up (P<0.001, Tukey's Honest Significant Difference). There was no statistically significant difference in CDVA between the two groups during each follow-up visits (P = NS, unpaired t-test) and in the CDVA improvement percentage between the two groups (P = 0.882, Chi-square test). No significant changes in CECD were noted after surgery in both groups (ANOVA Group A: P = 0.067, Group B: P = 0.330P). No intra-operative complications occurred in both groups. There was no statistically significant difference in the rate of complications between the two groups (P = NS, Chi-square test), except for pigment precipitates which were higher in Group A (P<0.05, Chi-square test).

CONCLUSIONS

Five-year follow-up shows that secondary implantation of aphakic IOLs is effective and safe for the correction treatment of aphakia in eyes without capsule support.

A new technique of needle-guided retropupillary fixation of iris-claw intraocular lens

The authors developed a new surgical technique of retropupillary implantation of an iris-claw intraocular lens (RP-ICIOL). RP-ICIOL is an alternative surgical option to the scleral-fixation technique for the treatment of aphakia without capsular support. Several studies have shown that RP-ICIOL is efficient and safe. However, although it is easier to perform than scleral fixation, it presents some critical issues related to the enclavation procedure. The success of the correct enclavation without excessive surgical manipulations, with subsequent pigment dispersion and without pupil distortion, is highly related to the surgical skills of the individual surgeon. The new technique proposed by the authors consists of using a guide needle to facilitate the enclavation, and to make this surgical procedure standard. The new technique was performed in 26 patients affected by aphakia without capsular support with encouraging functional and anatomical results.

Cystoid macular oedema and iris-fixated intraocular lens treated with intraocular lens exchange: A case series and review

This series of case reports describes six eyes from five patients that underwent intraocular lens (IOL) exchange with scleral-fixated IOLs for cystoid macular oedema associated with iris-fixated IOLs between 2005 and 2015. Macular oedema was assessed using ocular coherence tomography (OCT). The six eyes in this series were treated by IOL removal and implantation of a scleral-sutured IOL with four points of fixation in the sulcus. Visual acuity improved in all six eyes. On OCT, macular oedema resolved after 3 months in all eyes. There were no surgical complications from the IOL exchange. One eye had a pupilloplasty and another had a diaphragm IOL to treat a major iris impairment from prior surgeries. The cause of cystoid macular oedema in these cases remains controversial but has been well recognized in eyes with iris-sutured IOLs. The absence of sutures with posterior fixation of an iris claw IOL prevents progressive corneal endothelial cell loss but does not prevent macular oedema, even in vitrectomized eyes. In conclusion, macular oedema resolved and visual acuity improved after implant exchange with a secondary scleral-fixated IOL in these cases. This procedure should be considered as a solution to persistent symptomatic cystoid macular oedema from an iris-fixated implant.

Sutureless 27-gauge needle-assisted transconjunctival intrascleral intraocular lens fixation: Initial experience

PURPOSE

The purpose of the study was to report our initial experience with the transconjunctival Intrascleral Intraocular Lens (SFIOL) fixation with modified Yamane's double-needle technique and flanged haptics.

METHODS

This was a prospective interventional study that enrolled 31 consecutive patients undergoing SFIOL with the modified Yamane's technique. All patients underwent comprehensive evaluation including uncorrected and best-corrected vision, intraocular pressure, ultrasound biomicroscopy, endothelial cell density, and macular thickness using optical coherence tomography (OCT). We excluded patients with visually significant coexistent pathology such as corneal scars, macular pathology, and glaucoma.

RESULTS

The mean age of subjects was 57 ± 16.9 years and 23 were men (74%). Surgery was performed for aphakia following complicated cataract surgery in 10 eyes (32%), with lensectomy for subluxated/dislocated cataract in 6 eyes (19%), and with IOL explantation for subluxated/dislocated IOL in 15 eyes (48%). There were no intraoperative complications. Uncorrected visual acuity improved from median of 1.48 logarithm of minimum angle of resolution (logMAR) units (interquartile range [IQR] = 1.3-2 logMAR) at baseline to 0.3 logMAR (IQR = 0.2-0.4 logMAR) at 6 weeks (P < 0.001) which was maintained at 6 months. There were no significant changes in endothelial cell density (P = 0.34) and OCT-based macular thickness (P = 0.31) at 6 months. Two eyes had slight IOL decentration.

CONCLUSION

Our initial experience suggests that the Yamane's technique for SFIOL is a simple procedure with a short-learning curve and is independent of scleral flaps, tunnels, sutures, and fibrin glue. Using widely available 27-gauge needle instead of 30-gauge thin wall needle as originally described by Yamane makes it possible for the use of various three-piece IOLs available globally. Further studies are required for widespread acceptance of this technique.

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

PURPOSE

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.

METHODS

Fourteen eyes of children between the ages of 8-17 years 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.

RESULTS

Postoperatively, all patients had an increase in the BCVA with a mean of 0.351 ± 0.154 log MAR units which was statistically significant as compared to the preoperative value of 0.771 ± 0.132 log MAR units (p = 0.003). The difference between the mean preoperative IOP (13.642 ± 2.437 mmHg) and the mean postoperative intraocular pressure at the end of 6 months (13.5 ± 2.244 mmHg) 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 6 months 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 6 months.

CONCLUSIONS

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.

Primary iris claw IOL retrofixation with intravitreal triamcinolone acetonide in cases of inadequate capsular support

PURPOSE

To assess the outcomes and analyze complication rates following primary iris claw IOL retrofixation with intravitreal triamcinolone acetonide.

METHODS

This is a retrospective interventional case series. Patients with poor capsular support-diagnosed preoperatively or owing to intraoperative complications-were treated with iris claw IOL retrofixation with intravitreal triamcinolone acetonide. The data were retrospectively analyzed.

RESULTS

104 eyes of 102 patients with poor capsular support who underwent the procedure between 2010 and 2013 were analyzed. The minimum follow-up period was 12 months (ranging from 12 to 36 months). Iris claw IOL was implanted in-traumatic subluxated cataracts-24 cases (23.07%), non-traumatic subluxated cataracts in 16 cases (15.38%), or as a complication of cataract surgery-intraoperative posterior capsular rent in 48 cases (46.15%) and intraoperative nucleus drop in 16 cases (15.38%). The final mean best-corrected logMAR visual acuity improved from 1.36 ± 0.64 preoperatively to 0.36 ± 0.32 at 1-year follow-up. Complications included pupil ovalization in 11 cases (10.57%), transient elevation in intraocular pressure in 7 eyes (6.73%), postoperative hypotony in 5 eyes (4.80%), cystoid macular edema in 2 eyes (1.92%), retinal detachment in 1 eye (0.96%), vitreous hemorrhage in 1 eye (0.96%), and hyphema in 1 eye (0.96%).

CONCLUSION

Primary iris claw IOL retrofixation provided excellent alternative in patients with inadequate capsular support. The visual outcomes were good along with favorable rates of complications. The addition of triamcinolone acetonide helps in reducing the chances of cystoid macular edema.

Retropupilar positioning of foldable iris-claw intraocular lens for correction of aphakia with no capsular support

Summary

Iris-claw intraocular lens (ICIOL) for aphakia needs a large 5.4 mm corneal incision for its implantation. The technique needs corneal suture, associated with some postoperative astigmatism. Foldable ICIOL is used in phakic patients undergoing refractive surgery and has the advantage of a sutureless small corneal incision. We report a case of a high myopic patient with dislocated intraocular lens (IOL) and no capsular support. Dislocated IOL with its capsular bag was released with three-port, 23-gauge vitrectomy; placed in the anterior chamber; sliced; and extruded through a 3.2-mm corneal incision, where a foldable ICIOL was introduced and placed retropupillary. This technique achieved a stable fixation of the IOL. Retropupillary implantation of a foldable ICIOL on aphakic patients has advantages over that of a polymethylmethacrylate (PMMA) ICIOL due to smaller corneal incision. The technique may be safe and easy to perform.

Purpose

The purpose of this report was to describe the technique of retropupillary implantation of a foldable iris-claw intraocular lens (ICIOL) in a patient with dislocated intraocular lens (IOL) in mid vitreous cavity.

Methods

Foldable ICIOL (Artiflex^® Myopia Model 401) is used in phakic patients undergoing refractive surgery and has the advantage of a sutureless small corneal incision. We report a case of a high myopic patient with dislocated IOL and no capsular support. The calculation was a −5.0 D IOL for retropupilar position, and a foldable ICIOL was introduced through a 3.2-mm corneal incision and placed retropupillary.

Results

The technique was easy to achieve. IOL was properly positioned retropupillary and maintained stable. There was no ocular hypertension and no anterior chamber flare or iris atrophy.

Conclusion

Retropupillary implantation of a foldable ICIOL on aphakic patients has advantages over that of a PMMA ICIOL due to smaller corneal incision. The technique may be safe and easy to perform.

Sutureless 25-Gauge Pars Plana Vitrectomy Combined with Retropupillary Fixation of an Iris-Claw Intraocular Lens

Background

The surgical case of a dropped intraocular lens inside the vitreous cavity constitutes a real challenge for the operating surgeon. Herein, we describe a case series where an alternative optical rehabilitation technique for late intraocular lens-bag complex dislocation has been used.

Methods

A modern vitrectomy device was used to remove the capsule with the dropped intraocular lens using sutureless 25-gauge pars plana vitrectomy. To ensure a better aesthetic result, with faster patient recovery and a reduced number of operations, the whole procedure was performed during the same operating session; an iris-claw intraocular lens for aphakia was selected for implantation. The implant was passed behind the constricted iris with the concave surface facing it. The lens was grasped with the manufacturer's holding forceps and fixed onto the posterior surface of the iris using the special enclavation needles.

Results

We have operated 12 eyes in two different clinical centres successfully, with minimal intra- and/or postoperative complications.

Conclusion

We believe that this is a viable solution for the visual rehabilitation of patients, who would otherwise need more than one operation for a lens exchange.

Retropupillary iris claw intraocular lens implantation in aphakia for dislocated intraocular lens

Background

Nowadays, dislocated intraocular lenses (IOLs) and inadequate capsular support are becoming a challenge for every ophthalmic surgeon. Explantation of dislocated IOL and iris claw IOL (ICIOL) are the techniques that have been used in our ophthalmic department. The aim of this study is to report our technique for retropupillar ICIOL.

Methods

This study is a retrospective case series. A total of 105 eyes with dislocated IOL from the patients at the Department of Ophthalmology in Santa Maria Hospital, a tertiary reference hospital in Lisbon, Portugal, from January 2012 until January 2016, had been analyzed. Of these 105 eyes, 66 eyes had dislocated one-piece IOL and 39 eyes had dislocated three-piece IOL. The latter underwent iris suture of the same IOL and were excluded from this study. The remaining 66 eyes with dislocated one-piece IOL underwent pars plana vitrectomy, that is, explantation of dislocated IOL through corneal incision and an implantation of retropupillary ICIOL. Operative data and postoperative outcomes included best corrected visual acuity, IOL position, intraocular pressure, pigment dispersion, clinical signs of endothelial cell loss, and anterior chamber depth.

Results

The mean follow-up was 23 months (range: 6–48 months). The mean preoperative best corrected visual acuity was 1.260±0.771 logMAR, and postoperative best corrected visual acuity was 0.352±0.400 logMAR units. Mean vision gain was 0.909 logMar units. The patients had the following complications: 1) retinal detachment was found in one patient, 2) corneal edema was found in three patients, 3) high intraocular pressure was observed in twelve patients, 4) subluxation of the IOL was observed in one patient, and 5) macular edema was found in three eyes.

Conclusion

The results demonstrate that retropupillary ICIOL is an easy and effective method for the correction of aphakia in patients not receiving capsule support. The safety of this procedure must be interpreted in the context of a surgery usually indicated in complicated cases.

Outcomes of Sutureless Iris-Claw Lens Implantation

Purpose. To evaluate the indications, refraction, and visual and safety outcomes of iris-claw intraocular lens implanted retropupillary with sutureless technique during primary or secondary operation. Methods. Retrospective study of case series. The Haigis formula was used to calculate intraocular lens power. In all cases the wound was closed without suturing. Results. The study comprised 47 eyes. The mean follow-up time was 15.9 months (SD 12.2). The mean preoperative CDVA was 0.25 (SD 0.21). The final mean CDVA was 0.46 (SD 0.27). No hypotony or need for wound suturing was observed postoperatively. Mean postoperative refractive error was −0.27 Dsph (−3.87 Dsph to +2.85 Dsph; median 0.0, SD 1.28). The mean postoperative astigmatism was −1.82 Dcyl (min −0.25, max −5.5; median −1.25, SD 1.07). Postoperative complications were observed in 10 eyes. The most common complication was ovalization of the iris, which was observed in 8 eyes. The mean operation time was 35.9 min (min 11 min, max 79 min; median 34, SD 15.4). Conclusion. Retropupilary iris-claw intraocular lens (IOL) implantation with sutureless wound closing is an easy and fast method, ensuring good refractive outcome and a low risk of complication. The Haigis formula proved to be predictable in postoperative refraction.

Iris-claw versus posterior chamber fixation intraocular lens implantation in pediatric traumatic cataract

Aim:

This study aims to compare visual outcomes and complications of iris-fixated (claw) intraocular lens (IFIOL) implantation with those of posterior chamber intraocular lens (PCIOL) implantation in children with traumatic cataract.

Settings and design:

Retrospective observational clinical audit.

Materials and methods:

A total of 50 pediatric traumatic cataract cases that underwent lens removal and IOL implantation (IFIOL or PCIOL) with or without corneal or corneoscleral tear repair between January 2009 and December 2013 were analyzed. After meeting the eligibility criteria, their pre- and postoperative visual outcomes and complication rates were recorded. Data were analyzed descriptively.

Results:

Out of 50 children, IFIOL and PCIOL implantations were performed in one eye of each of 25 children. Their mean age was 11 ± 4 years (range 4–18 years). Primary (cataract removal with lens implantation) and secondary (corneal tear repair followed by cataract removal with lens implantation) procedures were performed in 19 (76%) and six (24%) children in the IFIOL group and in 21 (84%) and four (16%) children in the PCIOL group, respectively. There was an improvement in best corrected visual acuity postimplantation in both the IFIOL and the PCIOL group, and no significant difference in the logarithm of the minimum angle of resolution of best corrected visual acuity was observed between the two groups over 36 months. Only three eyes in the IFIOL group developed complications: one eye developed secondary glaucoma, one disenclavation of IOL haptic, and one cystoid macular edema.

Conclusion:

Both IFIOL and PCIOL implantations have good visual outcomes and minimal postoperative complications; therefore, IFIOL can be used as an alternative to PCIOL in children with traumatic cataract with inadequate capsular support.

Long Term Clinical and Visual Outcomes of Retrofixated Iris Claw Lenses Implantation in Complicated Cases

Aims:

To evaluate the visual outcomes and complications after implantation of retrofixated iris claw (RFIC) lens in various challenging situations.

Settings and Design:

Retrospective, single centre, 8 year clinical audit.

Materials and Methods:

A retrospective analysis of cases who underwent RFIC lens implantation alone (group 1) or in combination with vitreoretinal (VR), corneal or glaucoma procedures (group 2) was performed. The main outcomes evaluated were corrected distant visual acuity (CDVA) and postoperative complications. The mean follow up was 13.09±6.8 (range 6-24) months.

Results:

The study involved 100 eyes of 83 patients with mean age of 51.1±25.4 years. Group 1 included 59 eyes and group 2 had 41 eyes. In group 1, the mean CDVA improved from 0.86±0.81 to 0.38±0.51 LogMAR (p<0.001) with 72.8% eyes having gain in lines (≥ 2 lines) of CDVA with safety index of 1.73. The mean CDVA in group 2 improved from 0.71±0.65 to 0.38±0.34 LogMAR (p=0.003) with 65.8% eyes having gain in lines (≥ 2 lines) of CDVA with a safety index of 1.54. Group 2 showed a higher complication rate of 36.59% compared to group 1 (20.34%). Significant complications noted were secondary glaucoma (8%), disenclavation of haptic (4%), subluxation of RFIC lens (1%).

Conclusion:

The visual outcome with RFIC lenses when combined with other intraocular procedures is mainly affected by the complexity of co-existing pathologies .The complications are more related to the combined procedures performed rather than RFIC lens implantation alone. This may still be acceptable when complication profile of other intraocular lenses is evaluated in similar challenging situations.

Long-term follow-up of retropupillary iris-claw intraocular lens implantation: a retrospective analysis

BACKGROUND

The ideal intraocular lens in cases of aphakia without capsular support is debated. Choices include anterior chamber lenses, iris- or scleral-sutured lenses, and iris-claw lenses. Our aim was to report our long-term evaluation of the use of retropupillary implantation of the Artisan iris-claw intraocular lens (RPICIOL) in several aphakic conditions without capsular support.

METHODS

A retrospective analysis of consecutive 320 eyes of 320 patients (222 males and 98 females) without capsular support in which we performed RPICIOL implantation in post-traumatic aphakia (141 eyes, group 1), post-cataract surgery aphakia (122 eyes, group 2), and in cases in which penetrating keratoplasty was associated with vitrectomy (57 eyes, group 3). Either anterior or posterior vitrectomy procedures were performed with 20-, 23-, or 25-gauge techniques for different associated anterior or posterior segment indications. We reviewed the refractive outcome, anatomical outcome, long-term stability of the implants, and possible long-term complications.

RESULTS

The mean patient age was 59.7 years (range, 16-84 years) in group 1; 60.1 years (range, 14-76 years) in group 2; and 65.8 years (range, 25-71.5 years) in group 3. The mean follow-up time was 5.3 years (range, 1 month to 8 years). At the end of the follow-up period, the mean post-operative best-corrected LogMAR visual acuity was 0.6 (range, perception of light to 0.3) in group 1; 0.3 (range, 0.5-0.1) in group 2; and 0.6 (range, hand movement to 0.2) in group 3. Disenclavation of RPICIOLs occurred in three cases because of slippage of one of the iris-claw haptics and spontaneous complete posterior dislocation occurred in one case. One case presented with retinal detachment, and no cases of uveitis were observed. Eight cases complained of chronic dull pain, and severe iridodonesis was seen in five cases. One case of post-operative macular edema was observed without post-operative increase in the mean intraocular pressure. There was no statistically different change in the endothelial cell density (cells/mm(2)) at the end of the follow-up period.

CONCLUSIONS

RPICIOL for secondary implantations is a valid alternative strategy to scleral-fixated or angle-supported IOL implantation.

[Retropupillary iris claw intraocular lens implantation technique for aphakia]

BACKGROUND

Overview of the retropupillary implantation of iris claw intraocular lenses (Artisan®,Ophtec, Groningen, Niederlande and Verisyse(TM),AMO, Santa Ana CA).

MATERIAL AND METHODS

A literature search and review of implantation techniques, patient selection, potential complications and management strategies.

RESULTS

This approach has the advantage of a simple implantation technique, an anatomically correct implantation site (as compared to endocapsular implantation) and a relatively low complication rate. An intact iris is, however, a prerequisite for this technique. Ischemic vitreoretinopathies, such as diabetes or vascular occlusive entities, as well as uveitis might be considered as contraindications.

CONCLUSIONS

The retropupillary implantation of iris claw intraocular lenses is an interesting and especially time-effective rehabilitation technique for aphakia.

Iris-claw, retropupillary-fixated, aphakic intraocular lens implantation for traumatic aphakia following penetrating keratoplasty

We report the correction of aphakia using an iris-claw, aphakic intraocular lens (IOL) fixated in a retropupillary location in a 17-year-old young man who suffered blunt trauma to his eye 5 months after penetrating keratoplasty (PKP). There were no intraoperative complications. At 21 months after implantation, the patient's uncorrected distance visual acuity was 20/28; his corrected distance visual acuity was 20/22, with +0.50 -3.00 × 155. Intraocular pressure was normal, and endothelial cell count was 1798 cells/mm(2).

Posteriorly enclavated iris claw intraocular lens for aphakia: long-term corneal endothelial safety study

PURPOSE

To report 2 years follow-up experience, corneal endothelial cell loss results, and A constant used in retroiridis-fixated iris-claw aphakic intraocular lens (IOL) secondary implantation to correct aphakia in eyes without adequate capsule support.

METHODS

In this prospective, interventional, clinical case series, 16 consecutive eyes of 14 patients (13 adults and 1 child) underwent retroiridis implantation of Artisan iris-claw aphakic IOL (Ophtec BV, Groningen, the Netherlands). Outcome measures included spherical equivalent (SE) of refractive error, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) expressed as the logarithm of the minimum angle of resolution (logMAR), endothelial cell density (ECD), and complications, including raised intraocular pressure (IOP) and pigment dispersion.

RESULTS

All eyes were followed up for 2 years postoperatively. Postoperative SE of refractive error was between -1.25 and +1.63 D in all eyes at last follow-up. The mean CDVA was 0.27 ± 0.30 logMAR preoperatively and 0.13 ± 0.21 logMAR at 2 years postoperatively (p = 0.0188). Postoperative UDVA mean was 0.31 ± 0.26 logMAR at last follow-up. Preoperative manual ECD mean of 2269 ± 611 cells/mm2 decreased postoperatively to 2002 ± 532 cells/mm2 at 2 years (p = 0.0005) (mean endothelial cell loss of 11.9 ± 2.0%). No intraoperative complications occurred. There was no significant postoperative IOP increase throughout the follow-up. Iris pigment precipitates on the IOLs occurred in 1 eye (6.3%). No other serious complications occurred.

CONCLUSIONS

Two-year results show that retroiridis-fixated iris-claw aphakic IOL implantation is an effective and safe method with regards to corneal endothelial cell loss, and a new A constant is suggested.

[Retroiridal implantation of a Verisyse™ iris claw lens: refractive outcome and individualized intraocular lens constants]

BACKGROUND

Evaluation of refractive predictability with retroiridal implantation of a Verisyse(TM) iris-claw lens (AMO) and optimization of the IOL-constants recommended by the manufacturer.

PATIENTS AND METHODS

A retrospective study after retroiridal iris-claw lens implantation in the years 2007-2012 including 52 eyes of 50 patients with a lack of capsular support was carried out. Follow-up data was recorded on average 5 weeks after surgery. Demographic data, indications, accompanying diseases, biometrical data and refractive outcome were analysed and an individualization of the intraocular lens constants for the SRK/T-, Holladay-1, Hoffer-Q and Haigis-formula was carried out.

RESULT

Indications for retroiridal implantation of a Verisyse(TM) lens were IOL luxation (32.7 %), complicated primary cataract surgery (25.0 %), secondary IOL Implantation (19.2 %), lens exchange (19.2 %) and luxation of the crystalline lens (3.8 %). Accompanying diseases were pancreatic diabetes (21.2 %), rheumatic diseases (7.7 %), homocystinuria (1.9 %), pseudoexfoliation of lens capsule (23.1 %), traumata (23.1 %), secondary glaucoma (23.1 %), proliferative diabetic retinopathy (9.6 %) and age related macular degeneration (5.8 %). Optimized IOL constants were an A-constant of 116.8 for the SRK/T formula, a surgeon factor (Holladay1) of 0.8, a pACD (HofferQ) of 4,4 and an a0 constant of 0,49 for the Haigis formula. Postoperative deviation of target refraction was within ± 2 D in 84.6 % of the eyes.

CONCLUSION

The retroiridal Verisyse(TM) intraocular lens shows a broad spectrum of indications and achieves a good visual outcome. The previously published IOL constants show optimization potential due to the small number of cases.

[Anterior chamber intraocular lenses for aphakia correction]

The intraocular correction of aphakia in the anterior chamber currently consists of two options: an angle supported intraocular lens (IOL, Kelman Multiflex) and an iris fixated IOL (Artisan/Verisyse). The angle supported IOL is fixated with four haptic points in the anterior chamber and the iris fixated IOL is enclavated to the anterior iris surface. Acceptable results of both IOLs are reported in the literature; however both IOLs show some long-term complications in some eyes. Alternatives to these anterior chamber IOLs to correct aphakia are the retropupillary fixated Artisan and sclera fixated IOLs.

Aphakia correction with retropupillary fixated iris-claw lens (Artisan) - long-term results

PURPOSE

To evaluate the technique, safety, and efficacy of the retropupillary implantation of iris-claw intraocular lenses in a long-term follow-up study.

PATIENTS AND METHODS

This retrospective study included 31 eyes of 31 patients who underwent an Artisan aphakic intraocular lens implantation between January 2006 and February 2011 at the University Hospital Essen, Essen, Germany and at the Zentrum für Augenheilkunde PD Dr Laube, Düsseldorf, Germany. Preoperative data collected included demographics, etiology of aphakia, previous surgeries, preoperative eye pathology, intraocular pressure, clinical signs of endothelial cell loss, and best corrected visual acuity. Operative data and postoperative outcomes included the best corrected visual acuity, lens position, intraocular pressure, pigment dispersion, clinical signs of endothelial cell loss, development of macular edema, and other complications.

RESULTS

Thirty-one patients were included. The mean follow-up was 25.2 months (range: 4-48 months). The mean best corrected visual acuity postoperatively was 0.64 logarithm of the minimum angle of resolution (logMAR) and varied from 0 logMAR to 3 logMAR. Some patients had a low visual acuity preoperatively because of preoperative eye pathologies. In 22 patients the visual acuity improved, in two patients the visual acuity remained unchanged, and seven patients showed a decreased visual acuity. Complications were peaked pupils (n=10) and retinal detachment in one case. Four patients showed an iris atrophy and high intraocular pressure was observed only in one patient. Subluxation of the intraocular lens, endothelial cell loss, and macular edema were not observed.

CONCLUSION

The presented long-term results demonstrate that retropupillary iris-claw lens implantation is a safe and effective method for the correction of aphakia in patients without capsule support. This surgical procedure has the advantages of a posterior chamber implantation with a low intraoperative and postoperative risk profile.

Posterior iris-claw aphakic intraocular lens implantation in subluxated lenses due to Marfan syndrome

PURPOSE

To evaluate the indications, visual outcomes, and complication rate after posterior implantation of an iris-claw aphakic intraocular lens (IOL) in subluxated lenses due to Marfan syndrome.

METHODS

Eyes without adequate capsular support had posterior chamber iris-claw aphakic IOL implantation between 2006 and 2012.

RESULTS

This retrospective cohort study comprised 13 eyes of 10 patients (7 female, 3 male; mean age ± standard deviation, 34.7 ± 19.6; range 9-61 years). The mean follow-up was 37 months (range 6-74 months). The mean final postoperative best-corrected visual acuity was significantly (0.24 ± 0.36 logMAR) better at the last follow-up than 1 day preoperatively (0.72 ± 0.46 logMAR) (p<0.05). There was no significant change in intraocular pressure before and after surgery. The mean endothelial cell density decreased from 2793 ± 478 cells/mm2 preoperatively to 2637 ± 612 cells/mm2 at last follow-up, representing a mean endothelial cell loss of 5.6%. Complications included early transient postoperative hypotony in 2 eyes (15.4%), slight persistent pupil ovalization in 1 eye (7.7%), and retinal detachment in 1 eye (7.7%).

CONCLUSIONS

The posterior implantation technique of aphakic iris-claw IOL provided good visual outcomes with a favorable complication rate and can be used as a reasonable alternative in subluxated lenses due to Marfan syndrome without adequate capsular support.

Posterior iris-claw aphakic intraocular lens implantation in children

PURPOSE

To evaluate the indications, visual outcomes, and complication rate after posterior implantation of an iris-claw aphakic intraocular lens (IOL) in children.

DESIGN

Noncomparative retrospective cohort study.

METHODS

setting: Institutional practice. patients/intervention procedures: Seven eyes of 4 children without adequate capsular support had posterior chamber iris-claw aphakic IOL implantation between 2007 and 2012. main outcome measures: Visual acuity, endothelial cell changes, intraoperative and postoperative complications.

RESULTS

The mean age of the 3 boys and 1 girl was 12.0 ± 3.4 (SD) years (range 8-16 years). In all eyes, the mean postoperative best spectacle-corrected visual acuity (0.13 ± 0.17 logMAR) was statistically significantly better at the last follow-up than at 1 day preoperatively (0.60 ± 0.39 logMAR) (P < .05). The mean follow-up was 31 months (range 10-64 months). The mean endothelial cell density decreased from 3013 ± 155 cells/mm(2) preoperatively to 2831 ± 236 cells/mm(2) at last follow-up, representing a mean endothelial cell loss of 6.4%. No corneal decompensation, iritis, secondary glaucoma, or pupillary block occurred after surgery in any eye. Postoperative complications included transient postoperative hypotony in 1 eye and a traumatic dislocation of a posterior aphakic iris-claw IOL in 1 eye.

CONCLUSION

The posterior implantation technique of aphakic iris-claw IOL provided good visual outcomes with a favorable complication rate and can be used as a reasonable alternative for a wide range of indications in pediatric eyes without adequate capsular support.

Visual outcomes and complications following posterior iris-claw aphakic intraocular lens implantation combined with penetrating keratoplasty

BACKGROUND

To evaluate the indication, visual outcome, and complication rate after implantation of a posterior iris-claw aphakic intraocular lens (IOL) during penetrating keratoplasty.

METHODS

This retrospective study comprised 23 eyes (23 patients) without adequate capsule support undergoing posterior iris-claw aphakic IOL implantation (Verisyse/Artisan) during penetrating keratoplasty between 2005 and 2010. Mean follow-up was 18 months (range from 12 to 37 months).

RESULTS

The IOLs were inserted during an IOL exchange in 17 eyes and as a secondary procedure in six aphakic eyes. Pseudophakic bullous keratopathy with corneal scar after anterior chamber intraocular lens (ACIOL) was the main indication for penetrating keratoplasty in 16 eyes (69.6 %). The final corrected distance visual acuity (CDVA) in logMAR (mean 1.0 ± 0.46) improved significantly (p < 0.05) compared to the preoperative CDVA (mean 1.8 ± 0.73). Twenty eyes (86.9 %) had a final visual acuity in logMAR better than the pre-operative CDVA. The mean postoperative IOP 16.3 mmHg ± 4.0 was not significantly (p > 0.05) higher compared to the preoperative IOP 15.6 mmHg ± 5.1. Complications included slight temporary pupil ovalization in three eyes (13.0 %) and iris-claw IOL sublocation in three eyes (13.0 %); all IOLs could be easily repositioned. Cystoid macular edema occured in one eye (4.3 %) 8 weeks after primary surgery. All grafts remained clear without any sign of graft rejection.

CONCLUSIONS

Retropupillar iris-claw IOL during penetrating keratoplasty provides good visual outcomes with a favorable complication rate, and can be used for a wide range of indications in eyes without adequate capsule support.