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

Abstract

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.

Iris-Claw Intraocular Lens: Anterior Chamber or Retropupillary Implantation? A Systematic Review and Meta-Analysis

“…As a result, RP ICIOL may be better for eyes with ocular hypertension or borderline IOP before surgery. Performing a peripheral iridotomy has been recommended when the ICIOL is placed on the anterior surface of the iris to prevent papillary block and subsequent IOP elevation problems; however, that procedure may be unnecessary with the lens positioned behind the iris [ 22 , 25 , 32 ]. Peripheral iridotomies could also widen the iridocorneal angle [ 33 , 34 , 35 ].…”

Cataract in the Adult Eye Preferred Practice Pattern®

“…698,699 The implantation of iris-claw IOLs is an alternative in countries where they are commercially available. [700][701][702]…”

Retropupillary Iris-Claw Intraocular Lenses: A Literature Review

“…However, ICIOL can be implanted in cases with small iris defects and localized atrophic areas, provided such sites are avoided. 36 , 57 To achieve an optimal functional outcome, the pupil should preferably be of regular size and shape. Although ICIOL can be used in cases of dilated pupils secondary to traumatic sphincter damage, large pupil size may lead to optical disturbances from the edges of the optic and the haptics, and safe enclavation of the haptics may be practically challenging.…”

“… 58 On the other hand, in extreme miosis cases, ICIOL should be placed anterior to the iris to prevent sphincter trauma during implantation. 57 …”

“…On the other hand, a corneal incision can be preferred in cases of thin, brittle conjunctiva or marked conjunctiva-episcleral adherence. 57 …”