Retropupillary Iris-Claw Intraocular Lens and Pars Plana Vitrectomy in Aphakia Management

Abstract

To evaluate the outcomes and safety of retropupillary iris-claw intraocular lens implantation and associated pars plana vitrectomy.Methods: Multicenter, national audit of 325 eyes (325 patients). Demographics, surgical details, and complications are described. Visual acuity, intraocular pressure, and central retinal thickness assessed by optical coherence tomography were collected at 1, 3, 6, and 12 months after surgery. Kaplan-Meier curves were created to assess the cumulative probability of postoperative visual acuity and intraocular pressure levels, macular edema development, and corneal decompensation.Results: The cumulative probability of the final visual acuity #0.3 logarithm of the minimum angle of resolution ($20/40 Snellen) was 75.6% at 12-month follow-up. The probability of intraocular pressure .21, $25, and $30 mmHg was 48.1%, 33.1%, and 19.0%, and the probability of intraocular pressure-lowering drops was 50.9% at 12 months. Glaucoma surgery was required in 4.3% of the eyes (14/325). The cumulative probability of macular edema was 20.5% at 12 months and was greater in complicated cataract surgery than in intraocular lens-luxation eyes (26% vs. 16.7%, P = 0.04). Corneal transplantation was required in 2.8% of the eyes (9/325).Conclusion: This study on 325 eyes with aphakia or intraocular lens dislocation managed with the retropupillary iris-claw intraocular lens technique provides clinical outcomes in a real-world scenario, reporting relevant data for patient counseling and preoperative discussions.

Predictive Factors and Management of Macular Edema after Retropupillary Iris-Claw Intraocular Lens Implantation in Aphakia: National Multicenter Audit—Report 2

“…We believe that, taking into account the suboptimal response shown in our series to other treatment alternatives, the benefits of the DEX implant outweigh the risks, although the limited follow-up period prevents making robust statements in this field beyond 12 months. Standard complications associated with the DEX intravitreal implant were not different than the figures described in our previous study [ 4 ], and were not significantly higher with respect to eyes treated only with topical anti-inflammatory drops. With the provided data, we suggest that the DEX implant appears as a good, effective and safe option for the treatment of postoperative ME associated with RICI, with the precaution of informing patients about the potential risk of implant migration to the anterior chamber in the risk–benefit discussions.…”

“…All patients underwent RICI implantation and PPV after complicated cataract surgery without capsular support or IOL luxation. To date, scarce data are available in the literature about the real incidence and possible predictive factors of postoperative ME development after RICI implantation [ 4 , 5 , 6 , 7 , 22 ] and, similarly, there is no consensus about the optimal postoperative management of this condition. As far as we know, this is the first analysis specifically directed to investigate predictive factors, management and clinical outcomes of postoperative ME after RICI implantation.…”

“…Postoperative ME was one of the main complications of RICI implantation in our previously published report of this multicenter national cohort [ 4 ], resulting in a cumulative probability of 20.5% of ME development. This figure is substantially higher than the ones presented in previous reports [ 2 , 3 , 5 , 6 , 7 , 23 ], which may be explained by different factors such as differences in the surgical technique of RICI implantation (in our study all patients underwent PPV) or the cause of aphakia, with the only indications for RICI implantation considered in our series being complicated cataract surgery with no capsular support or IOL luxation.…”

“…Multicenter, retrospective, descriptive, real-world clinical practice review of eyes which developed postoperative ME after RICI implantation and PPV in eyes with previous complicated cataract surgery with no capsular support or IOL luxation in a 5-year period (2014–2019) [ 4 ]. All relevant data were systematically collected in a comprehensive spreadsheet distributed to the 14 participating centers and merged in a centralized database in the coordinating center for analysis.…”

“…Retropupillary Iris-Claw Intraocular lens (RICI) implantation has been described as an effective surgical option to solve aphakia after complicated cataract surgery or intraocular lens (IOL) luxation [ 1 , 2 , 3 , 4 ] Nevertheless, this technique presents a series of complications among which the development of postoperative macular edema (ME) has been defined as one of the main causes of visual loss after RICI implantation [ 4 , 5 , 6 , 7 ]. Postoperative ME has already been described after uneventful cataract surgery or pars plana vitrectomy, even though continuous improvements in surgical techniques and transformation to small incision surgery have significantly decreased its incidence in the last few years [ 8 , 9 , 10 , 11 , 12 , 13 ].…”