Comparison of flanged intrascleral intraocular lens fixation versus iris claw intraocular lens fixation: A retrospective study

Abstract

Purpose:To compare the visual outcome and complications of retropupillary fixated iris claw intraocular lens (IOL) and sutureless intrascleral IOL fixation using the flanged fixation technique at 1 year.Methods:In this retrospective study, eyes that underwent either iris claw or flanged SFIOL from January 2016 to July 2017 with a minimum of 1-year follow-up were enrolled. Improvement in visual acuity, intraocular pressure measurements, endothelial cell count, central macular thickness, and complications were compared between and within groups at 6 weeks, 3 months, and 1 year postoperatively.Results:Data from 150 eyes were analyzed (n = 90 in the iris claw group and n = 60 in the flanged SFIOL group). Posterior capsular rent was the most common indication for IOL implantation (n = 51, 34%). The iris claw and SFIOL groups were comparable in terms of demographics and baseline characteristics. There was significant improvement in uncorrected distance visual acuity (UCDVA) at 6 weeks in both groups (P = 0.77), and at 1 year, the UCDVA was comparable between groups (0.36 ± 0.32 in the iris claw group and 0.30 ± 0.28 in the SFIOL, P = 0.75). Transient elevation of intraocular pressure was seen slightly more in eyes with SFIOL (17%), while ovalization of the pupil was the main sequelae seen in the iris claw group (20%).Conclusion:Both iris claw IOL fixation and SFIOL using flange are viable options for surgical correction of aphakia. Visual outcomes are excellent at 6 weeks and are maintained till 1-year follow-up, and complication rates are acceptably low, although ovalization of pupil is common with iris claw IOLs.

Comparison of Clinical Outcomes among Conventional Scleral Fixation, Retropupillary Iris-claw Intraocular Lens Implantation, and Intrascleral Fixation

“…ECC loss after surgery can be caused by contact with surgical instruments and IOL during surgery and by the toxic effects of inflammatory mediators [ 22 ]. In previous studies, there was no significant difference in postoperative ECC between scleral fixation and RP-IOL implantation and between RP-IOL implantation and ISF; a decrease in postoperative ECC was observed in all three groups [ 23 , 24 ]. The results of this study were consistent with those of previous studies.…”

Scleral-fixated and iris-fixated intraocular lens implantation or fixation:meta-analysis

“…Advancements of sutureless SF IOLs include the recently introduced and widely adopted sutureless SF IOL technique with a flange, which has provided excellent outcomes. 6,25 A recent American Academy of Ophthalmology's Ophthalmic Technology Assessment by Shen et al compared the visual acuity and safety profile of different IOL techniques. The study did not find a significant difference in visual acuity outcomes when evaluating scleral fixation and iris fixation techniques.…”

Retropupillary Iris-Claw Intraocular Lenses: A Literature Review

“… 36 Kelkar et al, in their retrospective comparative study, experienced a transient rise of IOP more in eyes with scleral-fixated IOL (17%) than ICIOL (8%), which was managed with topical therapy. 49 Nevertheless, Madhivanan et al found that eyes with ICIOL (10%) experienced greater transient IOP spikes due to iritis than eyes with scleral-fixated IOL (0%). 55 …”

“… 68 Studies on retropupillary ICIOL have shown a considerable variation in ECL ranging from 3%-43%. 14–16 , 23 , 25 , 27 , 28 , 30–33 , 36 , 42–44 , 46 , 47 , 49–51 , 56 Dalby et al, in a prospective comparative clinical trial, observed no significant difference in ECL following ICIOL implantation (15%) and IOL repositioning (18%) for late in-the-bag IOL dislocation at the end of 2 years. 64 In contrast, Kristianslund et al reported a significant postoperative ECL of 10% in the ICIOL group and a non-significant postoperative ECL of 3% in the repositioning group.…”