Retropupillary Iris-Claw Intraocular Lenses: A Literature Review (original) (raw)
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Journal of Ophthalmology
Purpose. To compare the functional and clinical outcomes of the iris-claw intraocular lens (IOL) placed on the anterior versus posterior surface of the iris. Patients and Methods. A multicenter, retrospective study. Data on eyes that underwent anterior or retropupillary iris-claw IOL implantation because of inadequate capsular support secondary to complicated cataract surgery, trauma, and dislocated/opacified IOLs since January 2015 were analyzed. For study inclusion, evaluation results had to be available in the medical records both preoperatively and at 1 and 12 months after implantation. The following parameters were compared between the groups: best-corrected distance visual acuity (BCDVA), spherical and cylindrical refractive error, endothelial cell density (ECD), central macular thickness (CMT), and percentage and type of postoperative complications. Results. In total, 60 eyes of 60 patients aged 73 ± 13 years were included: 28 eyes (47%) involved anterior, and 32 eyes (53%) r...
BMC Ophthalmology, 2015
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), postcataract 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 postoperative 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.
Medicina, 2021
Background and Objectives: Iris-claw intraocular lens (ICIOL) could be implanted in the anterior chamber (AC) or retropupillary (RP) in eyes lacking capsular and/or zonular support. Several studies have focused on comparing the efficacy and complications of these two techniques and we designed this research to review the published literatures. Materials and Methods: Peer-reviewed studies were collected through network databases (PubMed, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov) and analyzed. The primary outcome was the standardized mean differences (SMDs) of pre- and post-operative corrected distant visual acuity (CDVA). The secondary outcome was the SMDs of pre- and post-operative intraocular pressure (IOP), endothelial cell counts (ECC), and the odds ratios (ORs) of post-operative IOP elevation and cystoid macular edema (CME). Comprehensive Meta-Analysis software was utilized to conduct statistical analysis. Results: Six studies (one randomize...
IP Innovative Publication Pvt. Ltd., 2018
Purpose: A comparison of the visual outcome and complications in anterior chamber intraocular lenses with those of retropupillary iris fixated lenses. Materials and Methods: A retrospective observational study done at tertiary hospital in South India. Records of patients who underwent small incision cataract surgery with either anterior chamber intraocular lens (ACIOLs) and retropupillary iris fixated lens implantation done between 2009 to 2016 were assessed. Demographic details, and data regarding pre operative status, intraoperative and postoperative events were noted, and compared. Results: Records of 50 patients of retro-pupillary iris fixated lenses and 44 patients of ACIOLs were analysed. Postoperatively, 42% of patients who had an iris claw had visual acuity better than 6/60, and 50% of patients in the ACIOL group had a visual acuity better than 6/60, in the immediate postop period. 33 patients (66%) in the iris claw lens group had a vision improvement of one line or more, while 26(60.4%) in the ACIOL had a vision improvement of one line or more. (p=0.214). The postoperative complications in both groups were similar. Conclusion: Good surgical technique is the main factor in determining the postoperative outcome notwithstanding the type of lens used, especially in the immediate postoperative period. Keywords: ACIOL, Retropupillary Iris-claw lens, Small Incision Cataract surgery, Postoperative complications, Visual outcome.
Visual outcomes following retropupillary iris-claw lens implantation
IOSR Journals , 2019
Purpose: To evaluate the technique , visual and safety outcomes of retropupillary iris-claw lens implantation in aphakic eyes. Method: All aphakic patients with inadequate capsular support with well defined iris were included. Prospective study was conducted from November 2018 to August 2019 in Ophthalmology department of J.L.N Medical College Ajmer. Surgery was done in two clinical settings in the form of primary implantation at time of cataract extraction surgery and other secondary implantation (who were already aphakic due to any cause). Results: Of the total 30 patients ,10 patients implanted primarily due to capsular rent or weakness of zonular support unmanageable by putting in ciliary sulcus and 20 were secondarily implanted who were already aphakic. At 6 months follow up very few complications noted.In 4 patients ovalization of pupil was noted, whereas high IOP observed only in 1 patient.In 2 patients severe inflammation in the form of AC cells was noted in 1 st month and decentered IOL was noted in only 2 patients.Most of the patients shown very good refractive outcome with minimum astigmatic error. Conclusion: This study suggests that retropupillary iris claw lens insertion is beneficial in aphakia, which is easy and fast method ensuring good refractive outcomes. This surgical procedure has the advantages of a posterior chamber implantation with a low intraoperative and postoperative risk profile.
International Ophthalmology, 2017
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%), nontraumatic 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.
Journal of Evidence Based Medicine and Healthcare
BACKGROUND Visual rehabilitation of aphakic patients include spectacle correction, contact lenses, and primary or secondary intra ocular lens (IOL) implantation. Spectacles are rarely used nowadays because of limited visual field, aniseikonia and peripheral refractive errors. Contact lenses are other options for correcting aphakia but can cause a lot of corneal complications. Options for correction of aphakic patients with lack of adequate capsular support include anterior chamber IOL (ACIOL), scleral fixated IOL (SFIOL), and iris fixated IOL. Implantation of a retropupillary IC-IOL provides the benefits of a PCIOL, and the duration of the surgery is also less. The retropupillary IC-IOL because of its position lowers the risk of endothelial decompensation is a better option. We wanted to evaluate the functional outcomes of retropupillary iris claw lens implantation. METHODS Secondary implantation of IC-IOL was done in 50 surgical aphakic eyes as a result of intraoperative posterior ...
The Open Ophthalmology Journal, 2016
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 l...
Iris-Claw Intraocular Lens Implantation in Various Clinical Indications: A 4-Year Study
Journal of Clinical Medicine, 2021
An iris-claw intraocular lens (IOL) has been widely used as a secondary implant in aphakic patients. The study presents the results of implanting the anterior chamber iris-claw Artisan IOL in cases of where an appropriate posterior capsular support is lacking. The study included 132 patients subjected to primary IOL implantation during complicated cataract surgery with damage to the posterior capsule (I), secondary implantation in aphakia (II), secondary implantation during penetrating keratoplasty (III), and secondary implantation during pars plana vitrectomy with luxated IOL extraction (IV). We analyzed the records of best-corrected visual acuity (BCVA), spherical equivalent (SE), intraocular pressure (IOP), and corneal endothelial cell count (cECC), taken before and 1, 2, 3, and 4 years after the surgery. BCVA depended on the time after IOL implantation and the primary indication. Four years post-surgery, the SE values were the lowest in group III. IOP was the same in all groups ...