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

Abstract

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.

Fig. 1

a–e: RPICIOL implantation in a post-traumatic aphakia case with iridodialysis. a Aphakia with large iridodialysis; b Iris suturing with 10–0 polypropylene; c The IOL was introduced into the anterior chamber and oriented orthogonal to the corneal tunnel; d Positioning of the iris-claw lens behind the iris and enclavation of the iris tissue in the right haptic using a long spatula. Next, fixation of the haptic proximal to the paracentesis was performed using the same spatula; e Iris reconstruction completed and RPICIOL implanted. f–j: RPICIOL implantation in a post-cataract surgery aphakia case. f 25-gauge infusion into the anterior chamber and introduction of the RPICIOL; g The iris-claw lens was rotated and oriented in the horizontal meridian (3 to 9 o’clock) with a hook; h–i The RPICIOL was held with special forceps and enclavation of iris tissue in the claws of the lens was performed with a long spatula introduced through a lateral paracentesis by applying light pressure on the iris mid-periphery at the site exactly overlying the haptics, first at 9 o’clock then at 3 o’clock; j Immediate post-operative outcome; the IOL was stable and centered. k–o: RPICIOL implantation in a post-traumatic aphakia case. k Anterior dislocation of a posterior chamber IOL in the anterior chamber with iris laceration; l Removal of the dislocated IOL; m Iridoplasty with polypropylene 10–0 suture; n Introduction of the iris-claw lens; o The eye after finishing the operation. p–t: RPICIOL implantation in a post-cataract surgery aphakia case. p–q Posterior dislocation of a posterior chamber IOL in the vitreous cavity; r Removal of the posteriorly dislocated IOL after vitrectomy, to the anterior chamber; s–t Introduction of the iris-claw lens, and the eye after finishing the operation