Retropupillary fixation of iris-claw intraocular lens versus trans-scleral suturing fixation for aphakic eyes without capsular support

Abstract

Purpose The aim of this work was to compare retropupillary fixation of an iris-claw intraocular lens (IOL) (Verisyse) with trans-scleral suturing fixation for aphakic eyes without sufficient capsular support as regards the safety and complications of the procedure. Design This study was an interventional comparative prospective one. Patients and methods A total of 42 aphakic eyes of 40 patients were divided into two equal groups: 21 eyes were offered iris-claw IOL and 21 eyes were implanted with scleral-fixed IOL. Intraoperative data (mainly surgical time and intraoperative bleeding) and postoperative data [mainly corrected distance visual acuity (CDVA), intraocular pressure, and postoperative complications] were compared between the two groups during the follow-up period (first day,1 week, 2 weeks,1 month, and after 3 months). Results The mean surgical time in the iris-claw group was 24.77 ± 4.8 min, whereas the mean surgical time in the scleral fixation group was 67.09 ± 8.1 min, with a statistically significant difference between the two groups. On the first postoperative day, the CDVA ranged from 0.06 to 0.5 in the iris-claw group, with a mean of 0.22 ± 0.116, and it ranged from 0.05 to 0.15 in the scleral fixation group, with a mean of 0.10 ± 0.032; there was a statistically significant difference between the groups (P = 0.00021). However, after the first 3 months postoperatively, the CDVA ranged from 0.25 to 1.0 in the iris-claw group, with a mean of 0.51 ± 0.25, and it ranged from 0.15 to 0.6 in the scleral fixation group, with a mean of 0.42 ± 0.16; there was no statistically significant difference between the two groups (P = 0.152). On the first postoperative day, the mean intraocular pressure in the iris-claw group was 15.62 ± 2.59 mmHg, whereas in the scleral fixation group it was 19.62 ± 3.94 mmHg, with a statistically significant difference between the two groups (P = 0.00038). The iris-claw group showed higher rates of anterior chamber reaction, pupillary distortion, and cystoid macular edema postoperatively. In contrast, the rates of corneal edema, vitreous hemorrhage, and conjunctival erosion were higher in the scleral fixation group. Conclusion From our results, it is evident that iris-claw IOLs have now matured to a stage when they can be used with considerable safety and efficacy. The new designs, as well as the evolution of surgical techniques and instrumentation, have made them the best option for primary or secondary implantation in aphakic eyes. The surgical procedure is easier, shorter, and safer than those used for scleral-sutured IOLs.

Keywords

• aphakia
• retropupillary iris-claw
• scleral fixation