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Hyungil Kim,1 Sohee Jeon2 1Gyeongju St. Mary’s Eye Clinic, Gyeongju-si, Gyeongsangbuk-do, Republic of Korea; 2Keye Eye Center, Seoul, Republic of KoreaCorrespondence: Sohee JeonKeye Eye Center, 326 Teheran-ro, Gangnam-gu, Seoul, KoreaTel +82-02-6207-1236Fax +82-02-6207-1246Email soheeeee@gmail.comPurpose: To evaluate refractive outcomes after retropupillary iris-claw intraocular lens (IOL) implantation and to compare postoperative astigmatism from (1) a conventional 5.5-mm sclerocorneal incision, (2) an L-shaped scleral tunnel incision, and (3) a frown scleral tunnel incision.Methods: This was a retrospective study of eyes undergoing dislocated IOL exchange for a retropupillary iris-claw IOL. Uncorrected and corrected distance visual acuity (UDVA and CDVA) and postoperative complications were evaluated until postoperative months 24. The refractive outcomes and the surgically induced astigmatism (SIA) vector were compared between groups.Results: The medical records of 107 eyes from 107 patients with mean age of 65.31 ± 12.15 years were reviewed. Eyes with a frown incision showed the best UDVA, followed by those with L-shaped and conventional incisions (P = 0.003). Eyes with an L-shaped incision or frown incision had a lower SIA than that of the conventional incision group at postoperative 6 months (mean ± standard deviation [SD] SIA, 0.86 ± 0.85 D, 0.63 ± 0.37 D, and 1.70 ± 1.27 D for frown incision, L-shaped incision, and conventional incisions, respectively; P = 0.004).Conclusion: The frown incision and L-shaped incision induced a significantly smaller SIA than the conventional incisions, which was associated with better UDVA postoperatively.Keywords: aphakia, astigmatism, intraocular lens dislocation, retropupillary iris-claw intraocular lens, scleral tunnel incision, sclerocorneal incision

To compare the clinical features and long-term treatment outcomes of patients undergoing secondary intraocular lens (IOL) surgery with scleral-fixated (SFIOL) versus retropupillary iris-claw IOL (RPICIOL).Consecutive patients treated between June 2014 and December 2019 at two tertiary centres were retrospectively reviewed. The primary outcome was the best-corrected visual acuity (BCVA). Secondary outcomes included factors associated with significant corneal endothelial injury and postoperative redislocation.This study included 395 eyes undergoing surgery with SFIOL (237 eyes, 60%) or RPICIOL (158 eyes, 40%), with no differences in baseline BCVA (p = 0.76) or endothelial cell density (ECD) (p = 0.39). Compared with the SFIOL group, the RPICIOL group had faster visual recovery (postoperative month 1, 20/37 vs. 20/46, p = 0.005) sustained to over 36 months (p = 0.034), favourable absolute prediction errors (within 0.5D, 67.3% vs. 54.9%, p = 0.027), and shorter operation times (52.7 vs. 60.9 min, p = 0.015). There was no difference in ECD after 12 months (P = 0.282). Over a mean follow-up duration of 33 months (152 cases3 years, 38.5%), the SFIOL group experienced more cases of tilted/decentred IOLs (14 vs. 1, p = 0.006), suture exposure (7 vs. 0, p = 0.045), and redislocation (17.7% vs. 10.1%, p 0.001). Multivariable regression showed that a final BCVA below 20/40 was associated with SFIOL (P = 0.007), older age (p = 0.001), intraoperative complications (p = 0.002), past history of vitrectomy/glaucoma surgery or uveitis (p = 0.046), and surgically induced astigmatism1D (p = 0.029).RPICIOL appears to be a safe and effective surgical option for secondary IOL surgery over a long-term follow-up, comparing favourably against conventional SFIOL.

Background:Iris claw phakic intraocular lens [PIOL] is one of the surgical techniques used for the correction of high myopia. This procedure reduces myopia with stable refractive results and preserves the accommodation. Aim of the Work:The aim of this study is to assess the outcome of foldable and hard [PMMA] iris claw PIOL implantation as one of surgical procedures in the management of high myopic young patients. Patients and Methods:A prospective comparative study having foldable and hard [PMMA] iris claw phakic intraocular lens [PIOL] for correction of high myopia. This study includes forty eyes [40 eyes] of twenty high myopic patients [20 pt.] with refraction range of [-10.0 D to -25.0 D] without or with cylinder not more than [-2.0 D]. The patients were divided to two groups [A] and [B], each group contains twenty [20] eyes, the first 20 eyes [group A] received a concave-convex foldable iris claw PIOL and the remaining 20 eyes [group B] received a biconcave optic hard PMMA iris claw PIOL. Result:The mean postoperative SE at 6 months in group [A] was [-0.30 ± 0.10 D] within ±1.00 D of emmetropia. In group [B] it was [- 0.50 ± 0.50 D] within ±1.0 D of emmetropia. The mean postoperative cylinder at 6 months was [-0.31 ± 0.10] in group [A], and [-0.51 ± 0.51] in group [B]. There was a statistically significant difference between preoperative UCVA and postoperative UCVA at 6 months were [p

Background: A potential complication of cataract surgery is posterior capsular rent, where PCIOL can’t be implanted. Primary Iris claw implantation means that the IC-IOL is implanted in the same setting after cataract removal. While secondary Iris claw lens implant is done in an aphakic eye without capsular support and post cataract surgeries when the eye is left aphakic. Aim: To compare the visual outcome in cases of primary and secondary iris claw lens implantation after cataract surgery. This was a hospital-based Prospective Interventional Longitudinal study,conducted on patients in a tertiary care centre, in Western Maharashtra from September 2018 to August 2020. 31 eyes underwent primary iris claw implant and 19 underwent secondary iris claw implant. Results: Highly significant difference in visual acuity preoperatively due aphakia among subjects who underwent secondary iris claw implantation (p=0.000) was seen. Highly significant difference in visual acuity post operatively till 15 days was also seen due to less corneal oedema& inflammation in patients who underwent secondary iris claw implantation. No significant difference in visual acuity was seen on day 40 as lens was put in both the groups and the signs of inflammation had reduced (p=0.759). Conclusion: Overall visual outcome after 40 days is comparable in primary and secondary cases. It is better to do a primary retro fixated iris claw implantation, as in case of a secondary implant the patient will have undue anxiety, to undergo a second surgery along with increased financial burden and patient can develop complications due to aphakia. Keywords: Primary and Secondary Iris claw lens, Visual acuity, Endothelial cell count,Intra ocular pressure.

Cataract surgery via phacoemulsification with intraocular lens (IOL) placement in the capsular bag is the gold standard in the presence of adequate capsular support. However, when capsule and/or zonular fibers are weak or absent, alternate fixation strategies are required. Common alternative options include retropupillary iris-claw IOLs (RP-IC IOLs) and scleral-fixated IOLs (SF IOLs). In the present review of 87 articles with 2174 eyes implanted with RP-IC IOLs and 2980 eyes with SF IOLs, we discuss the published literature with respect to safety and efficacy. Although the studies reporting outcomes of these IOLs have been performed in patients with different concomitant conditions, visual and refractive outcomes were found to be comparable between RP-IC IOLs and SF IOLs. RP-IC IOL implantation seemed to provide equivalent or a potentially lower rate of complications than SF IOL implantation. Data from the literature also suggest that the surgical technique of RP-IC IOL implantation is relatively simpler with correspondingly shorter surgical times.

Mithun Thulasidas Cataract and Glaucoma services, Sankara Eye Hospital, Coimbatore, Tamil Nadu, 641035, IndiaCorrespondence: Mithun ThulasidasCataract and Glaucoma services, Sankara Eye Hospital, Sathy Road, Sivanandapuram, Coimbatore, Tamil Nadu, 641035, IndiaEmail mithun.thulasidas@gmail.comAbstract: Retropupillary iris-claw intraocular lenses (ICIOLs) have been increasingly chosen by surgeons nowadays as a primary or secondary procedure of IOL implantation in eyes with insufficient capsular or zonular support. They have gained popularity due to their simple fast technique, favourable functional outcomes, and safety. The transition in the ICIOL fixation from prepupillary to a more biologically appropriate retropupillary position and change in the optic design from biconvex to convex–concave have provided better visual outcomes and improved safety. A peer-reviewed literature search was conducted in Medline (PubMed), Embase, and Cochrane Library using the keywords “retropupillary iris claw” and “iris claw”. The search yielded 310 articles that were screened. Forty-three articles on retropupillary ICIOLs were finally found to be relevant and reviewed in full-text versions. The functional outcomes following retropupillary implantation of ICIOLs have been acceptable in eyes with no ocular co-morbidities otherwise. However, the indications for surgery may affect the outcomes. The major postoperative complications directly associated with ICIOLs include pupil ovalization and redislocation. Nevertheless, the rate of disenclavation depends on the experience and skill of the surgeon. This review is based on a literature review, and it focuses on the preoperative evaluation, surgical technique, postoperative outcomes, and associated complications. Prospective randomized trials with a larger sample size and longer follow-up are needed for comparison with other techniques of IOL fixation and confirmation of long-term safety profile.Keywords: iris-claw, retropupillary iris-claw, posterior iris-claw, IOL dislocation

Retropupillary iris-claw intraocular lenses (ICIOLs) have been increasingly chosen by surgeons nowadays as a primary or secondary procedure of IOL implantation in eyes with insufficient capsular or zonular support. They have gained popularity due to their simple fast technique, favourable functional outcomes, and safety. The transition in the ICIOL fixation from prepupillary to a more biologically appropriate retropupillary position and change in the optic design from biconvex to convex–concave have provided better visual outcomes and improved safety. A peer-reviewed literature search was conducted in Medline (PubMed), Embase, and Cochrane Library using the keywords “retropupillary iris claw” and “iris claw”. The search yielded 310 articles that were screened. Forty-three articles on retropupillary ICIOLs were finally found to be relevant and reviewed in full-text versions. The functional outcomes following retropupillary implantation of ICIOLs have been acceptable in eyes with no ocular co-morbidities otherwise. However, the indications for surgery may affect the outcomes. The major postoperative complications directly associated with ICIOLs include pupil ovalization and redislocation. Nevertheless, the rate of disenclavation depends on the experience and skill of the surgeon. This review is based on a literature review, and it focuses on the preoperative evaluation, surgical technique, postoperative outcomes, and associated complications. Prospective randomized trials with a larger sample size and longer follow-up are needed for comparison with other techniques of IOL fixation and confirmation of long-term safety profile.

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 capsular rent with zonular dialysis (N = 43, 86 %) & large (> 7 clock hours) zonular dehiscence (N = 7, 14 %). Follow up was done on 1 st day, 7th day, 1 month, 3 months and 6 months. RESULTS 22 males and 28 females in the age group 40 - 78 years were operated. 78 % eyes (N = 39) had vision better than 6 / 12 while only 10 % eyes (N = 5) had < 6 / 60 vision and the remainder 12 % (N = 6) had vision between 6 / 18 & 6 / 36. Complications like acute postoperative iritis (N = 18, 36 %) pupillary distortion (N = 15, 30 %), pigment clumping (N = 10, 24 %), iris chaffing (N = 9, 21 %), secondary glaucoma (N = 5, 12 %) and IOL decentration (N = 3, 7 %) were seen. The mean difference in central endothelial counts before surgery and 6 months after surgery was 109 cell / mm2 (5.92 %). CONCLUSIONS Iris claw lens gives the dual benefit of good visual acuity and less complication rate in aphakic patients with lack of adequate capsular support. KEYWORDS Retropupillary Iris Claw Lens, Surgical Aphakia, Secondary implantation, Zonular Dialysis, Aneisokonia

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.

Introduction: Iris-claw Intraocular Lens (IOL) is one of the alternatives to correct aphakia without sufficient capsular support. This technique is preferred because it has a simple procedure. Iris-claw IOL was originally designed to be fixated on the anterior chamber. The use of retropupillary fixation is increasing because the location is more physiologic and it shows less risk to corneal endothelial damage. Purpose: To describe safety and efficacy of iris-claw Artisan IOL in correcting aphakia without sufficient capsular support. Methods: This is a descriptive retrospective study of patients with aphakic iris-claw Artisan IOL implantation in National Eye Center Cicendo Eye Hospital, Indonesia from July 2017-July 2019. Patients were divided into prepupillary and retropupillary group. The Uncorrected Visual Acuity (UCVA), Best-Corrected Visual Acuity (BCVA), Safety Index (SI), Efficacy Index (EI), and complications were recorded. The procedure is safe if SI value ≥ 1.0 and effective if EI value ≥ 1.0. Results: There were 54 eyes in the retropupilary group and 17 eyes in the prepupillary group. In the prepupillary group, there were 94.11% eyes with SI ≥ 1.0, the mean SI was 1.79 ± 1.02, 50% of eyes with EI ≥ 1.0, and the mean EI was 0.77 ± 0.20. In the retropupillary group, there were 96.29% eyes with SI ≥ 1.0, the mean SI was 2.49 ± 2.23, 74.07% of eyes with EI ≥ 1.0, and the mean EI was 1.75 ± 1.64. Postoperative UCVA and BCVA were improved significantly compared to preoperative visual acuity in both groups (p < 0.05) Conclusion: Prepupillary and retropupillary iris-claw IOL implantation are safe. Retropupillary fixation technique is more effective in improving visual acuity.

We aimed to investigate the efficacy and safety of primary retropupillary iris claw intraocular lens (R-IOL) implantation in patients with complete intraocular lens (IOL) dislocation. In this single-center retrospective case series, we reviewed the medical records of patients who underwent R-IOL implantation surgery with pars plana vitrectomy for the treatment of IOL dislocation between September 2014 and July 2019. The primary outcome was change in visual acuity (VA) up to 24 months postoperatively. The secondary outcomes included changes in intraocular pressure (IOP), refractive errors, and endothelial cell count (ECC) over the same period. Data of 103 eyes (98 patients) were analyzed. The mean uncorrected VA was significantly improved at one month postoperatively (− 0.69 logMAR, P P = 0.008) and ECC (− 333.4 cells/mm2, P = 0.027) significantly decreased one month post-surgery and remained stable thereafter. Postoperative mean spherical equivalents were similar to the prediction error throughout the follow-up period. IOP elevation (n = 8, 7.8%), cystoid macular edema (n = 4, 3.9%), and dislocation of the R-IOL (n = 10, 9.7%) were managed successfully. Overall, primary R-IOL implantation with pars plana vitrectomy is effective and safe for correcting IOL dislocation due to various causes.

Background: The modern cataract surgery involves implantation of posterior chamber intraocular lens (PCIOL) when the posterior capsule is intact. However, in case of weak or no capsular support, PCIOL implantation is not possible. In such situations, implantation of secondary Iris claw lens (ICIOL) or Scleral fixated IOL(SFIOL) remains as treatment options. The aim of this study was to compare the efficacy of ICIOL and SFIOL in terms of visual outcomes and complications in aphakic patients. Methods: This prospective randomized study was done from January 2019 to December 2019. Forty aphakic patients fulfilling inclusion criteria, who attended the ophthalmology outpatient department of VVPF’s Medical college and hospital, Ahmednagar were included in this study. These patients were randomly divided into two groups such as Group 1 included 20 patients who underwent ICIOL implantation and Group 2 included 20 patients who underwent SFIOL implantation. The preoperative and postoperative evaluation was done with visual acuity, slit-lamp examination, IOP, fundus examination for the follow up period of 6 months. Results were analysed with Chi square test and t-test using SPSS software. Results: 85% ICIOL and 80% of SFIOL patients had final Best Corrected Visual Acuity (BCVA) of 6/18-6/6. Surgical time in ICIOL was significantly less than SFIOL group (p=0.00). Suture related complications were significantly more in SFIOL group. However, oval pupil and pigment dispersion were seen more in ICIOL group but were harmless. One patient in SFIOL group developed Cystoid Macular Edema (CME) which persisted till final follow up and 1 haptic of ICIOL was disenclavated which was re-enclavated. Conclusion: Comparable final visual outcome was found between ICIOL group and SFIOL group. However, Implantation of ICIOL required less surgical time with fewer complications and hence is a better alternative to SFIOL implantation in correction of aphakia.

In this case series, we report the use of the black Artisan iris-claw intraocular lens (IOL) (Ophtec, The Netherlands) in 6 patients with various visually debilitating symptoms requesting occlusion of one eye. Between 2016 and 2019, 6 (5 female, 1 male) patients underwent implantation of the custom-made black Artisan iris-claw IOL after other management strategies had failed to relieve their symptoms. The black Artisan IOL is an opaque anterior chamber IOL that is fixated to the iris by enclavation. Data were obtained from the electronic patient records (Epic, Verona, WI, USA). All implantation surgeries were uneventful. In terms of outcomes, 4 patients (67%) were satisfied with the result. In 2 patients (33%), the dysphotopic symptoms were not resolved, and these patients opted for either an enucleation or an evisceration. In conclusion, a black Artisan IOL is a valuable and – if needed – reversible option in the management of patients suffering from monocular debilitating visual symptoms leading to disturbances of binocular vision. The clinical presentation leading to the implantation of a pupil-occluding IOL varies and patient satisfaction following implantation is variable. Careful preoperative evaluation of patient factors and expectations, and stepped-care management is recommended to minimize treatment failure. Pupil-occluding lens implantation is often the last step in the treatment of intractable visual complaints in eyes with complex ophthalmologic history, before evisceration or enucleation.

PURPOSE: The purpose of this study was to compare the long-term efficacy and safety of posterior iris-claw lens and scleral-fixated posterior chamber lens for aphakia after traumatic posterior dislocation of the crystalline lens. MATERIAL AND METHODS: Out of 120 evaluated cases, 60 were randomly assigned in each group. A 23G vitrectomy was done and intraocular lens was implanted by two different techniques. Extensive preoperative and postoperative evaluation was performed including optical coherence tomography and Scheimpflug imaging. Follow-up was done on days 1, 7, and 28 at 3 months, 6 months, and 12 months. RESULTS: A significant improvement was found in uncorrected visual acuity in both the groups. Surgical time in iris fixation was significantly less (P < 0.001), whereas pupil peaking and pigment release were more. Difference in mean intraocular pressure and change in astigmatism in both the groups were insignificant. CONCLUSION: Both the techniques had similar good visual results. Although operating time was shorter for iris fixation, it had several disadvantages, including immediate postoperative inflammation and ovalling of the pupil. However, scleral fixation had a better outcome in terms of postoperative complications.

Purpose: To evaluate the visual outcomes, safety, efficacy, and causes of bilensectomy for iris fixated phakic intraocular lenses (pIOLs). Methods: This was a two center consecutive retrospective study that included 43 eyes that underwent iris-claw pIOL bilensectomy. Patients with follow up less than 4 months were excluded from the study. Uncorrected, corrected visual acuity (UCVA, CDVA), refractive outcomes, efficacy, safety (number of eyes in which the postoperative CDVA was worse than the preoperative CDVA), endothelial cell density (ECD), causes of bilensectomy, the time between the implantation of the pIOL and bilensectomy, intra and postoperative complications were analyzed. Results: There was a statistically significant improvement in UCVA and CDVA after surgery ( p = 0.001). The efficacy index was 0.7, four eyes had a postoperative CDVA worse than the preoperative CDVA. The mean spherical equivalent 1 year after bilensectomy was −0.78 ± 1.70 D. There was a statistically significant endothelial cell loss after iris claw lens bilensectomy ( p = .003). Cataract development and endothelial cell loss were the only reasons for bilensectomy. The mean time between pIOL implantation and bilensectomy was 12.2 ± 5.5 years. One patient had corneal edema 8 months after surgery and one had a retinal detachment 11 months after surgery. Conclusion: Bilensectomy was successful in improving UCVA and CDVA with an acceptable refractive outcome. Significant loss of ECD was found after surgery. The results recommend a larger ACD as selection criteria when choosing to implant an Artisan lens, and a close postoperative monitoring of the endothelial cell count.

Introduction: Cataract surgery with insufficient capsular support has become an intense challenge to surgeons in intraocular lens (IOL) selection. Anterior chamber IOL (ACIOL), iris-claw (Artisan) IOL, and scleral-fixated IOL (SFIOL) are the three common types of IOL used. However, each type of IOL has its own characteristics and different clinical requirements. IOL selection is important in ensuring good visual outcome. Purpose: The purpose is to compare the duration or surgery, visual outcomes, and complications among ACIOL, Artisan IOL, and SFIOL. Study design: Retrospective comparative analysis. Material and methods: This is a four-year retrospective analysis of patients who underwent either ACIOL, Artisan IOL, or SFIOL implantation between January 2014 and January 2018. Patients were divided into ACIOL, Artisan, and SFIOL groups. Demographic data, duration of surgery, preoperative and postoperative visual acuity, and postoperative complications were identified and compared among the different groups. Results: Sixty-four eyes from 58 patients were analysed: twenty (31.3%) eyes with ACIOL, 28 (43.8%) eyes with Artisan, and 16 (25%) eyes with SFIOL. Mean surgery times for ACIOL, Artisan, and SFIOL were: 61 ± 27.8, 64 ± 26.9, and 104.1 ± 46.8, respectively. SFIOL showed significantly longer surgery time than the ACIOL and Artisan groups (p < 0.05). There was no significant difference in surgery time between the ACIOL and Artisan groups (p > 0.05). The Artisan group showed significantly better visual recovery at postoperative 1 week than both the ACIOL and SFIOL groups (Artisan vs ACIOL: 6/18 vs 6/24, p < 0.05; Artisan vs SFIOL: 6/18 vs 6/60, p < 0.05). However, final best-corrected visual acuity (BCVA) at two months was comparable among all three groups with a median BCVA of 6/9. Elevated intraocular pressure occurred in all IOL groups, retinal detachment developedin the Artisan and SFIOL groups, epiretinal membrane developed in the ACIOL and SFIOL groups, corneal decompensation developed in the ACIOL group only. Cystoid macular oedema and IOL tilt occurred in SFIOL only. Conclusions: All three groups of IOL showed comparable good visual outcomes. The decision of IOL selection should be based on patients’ clinical condition and availability of surgical skill and resources.

Introduction: The modern cataract surgery is involved in implanting the posterior chamber intraocular lens (PCIOL) in the intact posterior capsule. However, the implantation of PCIOL is not possible in case of weak or no capsular support. In such situations, iris-claw lens (ICIOL) and scleral-fixated intraocular lens (SFIOL) remain as treatment options. Objective: The objective was to analyze the efficacy of ICIOL and SFIOL in terms of visual outcomes and complications. Materials and Methods: It was a prospective study with 30 aphakia patients fulfilling inclusion criteria. These patients were divided into two groups with 15 in each group. Group I patients underwent ICIOL and other 15 patients in Group II underwent SFIOL implantation. Patients with preexisting ocular pathologies were excluded. The preoperative and postoperative evaluation was done for the follow-up period of 6 months. Results were analyzed with Chi-square test and t-test using SPSS software. Results: In ICIOL group, 86.67% of patients and 80.6% of SFIOL patients had final best-corrected visual acuity (BCVA) 6/18–6/6. The mean logMAR BCVA in both groups was comparable. The surgical time in ICIOL was significantly less than SFIOL group (P = 0.00). Suture-related complications were significantly more in the SFIOL group. Complications found in the ICIOL group were harmless. Conclusion: The visual outcome was found to be comparable in both groups. ICIOL requiring less surgical time with fewer complications was found to be a good alternative to SFIOL in correction of aphakia.

Purpose: To evaluate the visual and anatomical outcomes of pars plana lensectomy and iris-claw artisan intra-ocular lens (IOL) implantation in the patients with subluxated crystalline lens secondary to Marfan syndrome.Methods: In this retrospective case series, we evaluate the records of all patients with Marfan syndrome and moderate to severe crystalline lens subluxation who underwent pars plana lensectomy/anterior vitrectomy and implantation of iris-claw artisan IOL at referral hospital from September 2015 to October 2019.Results: Twenty-one eyes of fifteen patients (10 males and 5 females) with the mean age of 24.47 ± 19.14 years were included. Mean best-corrected visual acuity was improved from 1.17 ± 0.55 logMAR to 0.64 ± 0.71 logMAR at the final follow-up visit (P Conclusion: Pars plana lensectomy and iris-claw artisan IOL implantation seem to be a useful, impressive and safe procedure with a low rate of complications in Marfan patients with moderate to severe crystalline lens subluxation. Visual acuity was significantly improved with the acceptable anatomical and refractive outcomes.

Here, we report a rare complication of the retropupillary iris claw intraocular lens (IOL) which in recent times has emerged as a good option for implantation in cases with inadequate capsular support following cataract surgery. Three weeks after undergoing iris claw IOL implantation, our patient presented with sudden decrease in visual acuity. On examination, we found the iris claw IOL to be tilted by 90° and lying perpendicular to the pupillary plane with the haptics still enclaved. Resurgery was done to reposition the IOL. The tremulousness of the iris causing an anterior movement of the iris diaphragm and IOL, aided by prolapse of vitreous could have caused the tilt.

Purpose To study the use of iris-claw Artisan intraocular lenses (IOLs) in patients with uveitis. Setting Moorfields Eye Hospital, London, England. Design Retrospective case series. Methods Data on all patients with anterior uveitis, intermediate uveitis, and panuveitis who had anterior-fixated Artisan IOL insertion between January 2014 and July 2019 at Moorfields Eye Hospital were assessed. Patients who had less than 2 months of follow-up were excluded from the analysis. Results The study comprised 11 patients. The mean age of the 7 women and 4 men was 61 years ± 14 (SD). The mean follow-up was 1.7 years. After Artisan IOL insertion, the corrected distance visual acuity (CDVA) improved significantly from 20/200 to 20/50 (P = .02). No patients had a significant flare-up of their uveitis after the surgery, and there were no intraocular pressure-related events. One patient developed cystoid macular edema, which responded to treatment. Conclusion This case series showed the efficacy and safety of Artisan-style IOLs in patients with a history of uveitis. After the Artisan IOL insertions, these patients experienced a significant improvement in CDVA with minimal side effects.

Objectives: To compare the outcomes and complications of dislocated intraocular lens (IOL) extraction and secondary iris-claw IOL (ICIOL) implantation in vitrectomized and non-vitrectomized eyes. Materials and Methods: This retrospective study included 19 vitrectomized eyes and 11 non-vitrectomized eyes that underwent dislocated IOL extraction and secondary anterior chamber ICIOL implantation between June 2014 and September 2017 and had at least one year of follow-up. Results: There were no significant differences between the groups in terms of demographic data, operative time, baseline anatomic and functional measurements, or postoperative changes in these measurements (all p>0.05). Postoperative best corrected visual acuity was significantly higher than preoperative values in both groups (both p0.05). In both groups, endothelial cell density was significantly lower at postoperative 1 year compared to preoperative measurements. There was no significant difference between groups regarding endothelial cell loss (p=0.49). One vitrectomized eye had corneal decompensation. Other complications included hyphema, transient increase of intraocular pressure, secondary glaucoma, pupillary irregularity, and dislocation of ICIOL. Mean operative time was 26.4±5.9 minutes. Conclusion: Dislocated IOL extraction and secondary anterior chamber ICIOL implantation is a safe treatment option in both vitrectomized and non-vitrectomized eyes.

BACKGROUND There are several alternatives for the surgical treatment of Aphakia (scleral fixation, intrascleral fixation, angle supported anterior chamber, ciliary sulcus supported, iris fixation intraocular lenses). Each technique has its own merits and demerits. Hence surgical correction of aphakia still remains challenging and controversial. The purpose of this study was to compare outcomes and complications of posterior fixated iris claw and sulcus supported lens from a tertiary care hospital. We wanted to compare visual outcome and complications of posterior iris claw intraocular lenses and sulcus placed intraocular lenses. METHODS This is a prospective interventional hospital-based study. A minimum of 60 patients fulfilling the inclusion criteria coming to our tertiary care hospital were selected for follow up study from January 2014 to December 2015. RESULTS 70.3% iris claw lenses and 76.6% of sulcus supported lenses had final BCVA 6/18-6/6. 26.5% iris claw lenses and 21.6% sulcus supported lenses had final BCVA in 6/60-6/24 group. Only 3.2% iris claw lenses and 1.8% were in less than 6/60 group. Mean logMAR visual acuity at the end of 6 weeks was comparable in both the groups. There were no significant differences between two groups in mean intraocular pressure at 1 week and at the end of 6 weeks. There was no significant difference between the two groups in operative complications. CONCLUSIONS Posterior fixed IOL was comparable to sulcus supported IOL in terms of BCVA at 6 weeks, intraocular pressure and operative complications.

Aim: The aim of this study is to study the indications, visual outcome, and complications in patients undergoing iris-claw intraocular lens (IOL) implantation. Settings and Design: This is a prospective interventional case series conducted between January 2016 and June 2017 in a tertiary care hospital. Materials and Methods: Seventy-nine eyes of 78 patients with aphakia or subluxation of lens of various etiologies were included in the study. Complete ophthalmological examination was conducted. Retropupillary iris-claw IOL implantation was done in the included patients. Patients were followed-up to 6 months for visual acuity, intraocular pressure measurement, and complications. Statistical Analysis Used: Statistical analysis was performed by the Students t-test. Results: The difference between preoperative and postoperative visual acuity was statistically significant in the group of patients undergoing iris-claw IOL implantation as a primary procedure (P < 0.0001). The difference was insignificant in the aphakic patients undergoing secondary IOL implantation. The interval between the primary surgery and the secondary procedure did not make a statistically significant impact on the visual outcome (P = 0.67). Common complications after iris-claw IOL implantation in this study noted were corneal edema, pupil ovalization, raised intraocular pressure, and iris atrophy. Conclusions: Retropupillary iris-claw IOL implantation is a safe and easy method of managing patients with aphakia and subluxation of the lens.

Background: Many reasons can lead to an aphakia without adequate capsular support for implantation of a posterior chamber intraocular lens (IOL), such as intraoperative unintentional rupture of posterior capsule during phacoemulsification, planned intracapsular cataract extraction, ocular trauma and lens dislocation due to congenital and acquired causes. Purpose: To compare Y-shaped intra-scleral fixation of a posterior chamber IOL with retro pupillary fixation of an iris-claw intraocular lens (IOL) for Aphakic eyes without sufficient capsular support as respects safety, visual recovery and complications of both methods. Patients and Methods: One hundred Aphakic eyes were arbitrarily distributed between two groups. Group A included 50 eyes treated with retropupillary fixation of iris claw lens and group B included 50 eyes treated with Y-shaped intra-scleral fixation technique. Preoperative, intraoperative and postoperative data were analysed including best corrected visual acuity (BCVA), intraocular pressure (IOP), surgical time, intraoperative problems, IOL malposition and postoperative complications. Following up on patients was carried out for at least six months. Results: The mean duration of surgery was 21 ± 5.3 min in group A and was 53.4 ± 6.9 min in group B (p-value 0.05). IOL tilt was found in 0 (0%) eyes in group A and in 5 (10%) eyes in group B (p 0.05). Conclusion: The results of our study indicated that both methods are satisfactory in correcting aphakia without sufficient capsular support as regards postoperative best corrected visual acuity (BCVA); however the surgical technique of retropupillary iris claw lens is easier, shorter, with low intra- and postoperative complications and safer than those used for intra-scleral fixation of IOL. But for eyes which lack both iris and capsular support, a scleral fixation of a posterior chamber IOL remains the only option.

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.

Background. The management of patients with aphakia and/or lack of capsular support remains debated. The sutureless posterior chamber IOL (PCIOL) fixation is a very useful surgical option. The purpose of the study was to compare the early outcomes as well as post-operative best corrected visual acuity, refractive errors and complications of two different techniques of sutureless PCIOL secondary implantation. Methods. Patients who underwent secondary implantation from December 2019 to January 2021 in the Department of Ophthalmology of Creteil Hospital, and in the Granville Ophthalmology Center, were retrospectively included. Eyes implanted with the iris claw lens (Artisan Aphakia IOL model 205, Ophtec BV, Groningen, The Netherlands) were included in group 1, and eyes implanted with a newly developed sutureless trans-scleral plugs fixated lens (STSPFL, Carlevale lens, Soleko, Pontecorvo, Italy) were included in group 2. Results. Twenty-two eyes of 22 patients were enrolled in group 1, and twenty eyes of 20 patients in group 2. No difference was found in visual acuity between two groups (0.35 +/− 0.29 logmar for group 1 and 0.23 +/− 0.51 logmar for group 2) (p = 0.15) at mean post-operative follow up (6.19 +/− 3.44 months for group 1 and 6.42 +/− 3.96 months for group 2) (p = 0.13). Both the mean refractive error (MRE) and induced astigmatism (IA) were greater in group 1 compared to group 2, respectively: the MRE was 0.99 +/− 0.57 vs. 0.46 +/− 0.36 (p &lt, 0.01), and IA was 1.72 +/− 0.96 vs. 0.72 +/− 0.52 (p &lt, 0.01). Conclusions. No significant differences in terms of the recovery of visual acuity were found between the two groups. Group 2 (STPFL) gives better results in our sample due to less post-operative induced astigmatism and less refractive error.

Background We discuss the safety, since their introduction, of phakic intraocular lenses (pIOLs) to correct refractive errors in healthy eyes. We investigated the reasons for pIOL explantation and the associated perioperative complications. Methods This retrospective, cross-sectional study included 69 pIOLs, explanted at a single tertiary center between July 2005 and March 2020: 34 angle-supported (G1), 28 iris-fixated (G2) and seven posterior chamber (G3) pIOLs. Case data including the reason for explantation was taken from the patient records. Intra- and postoperative complications were evaluated for an association with the pIOL. Results The mean duration in the eye was 10.4 (0.2–28) years. Cataractogenesis and subsequent surgery that required pIOL explantation was the reason in 42% of all cases. In 22%, cataract in combination with endothelial damage prompted explantation, with 26, 18 and 14% for G1, G2 and G3 respectively. The second most common reasons were corneal damage alone in the angle-supported group (26%), IOL subluxation in the iris-fixated group (18%), and photopic disturbance in the posterior chamber group (29%). In 68% of all explantations, the surgical course was unremarkable, while in the remaining cases perioperative complications were associated with the lens in 45.7%. Conclusion Overall, the need for cataract surgery was the most common reason for pIOL explantation. Corneal complications were more frequent in the angle-supported pIOLs and their removal was associated with higher rates of complication compared to the other groups.

INTRODUCTION: To compare the surgical outcomes of anterior chamber (AC) and posterior chamber (PC) implantation of iris claw lens (ICL) combined with penetrating corneal transplantation (P-CT), in eyes with no capsular support. METHODS: The records of 20 P-CT cases who underwent ICL implantation were retrospectively evaluated. The eyes were grouped according to the location of implantation; AC ICL and PC ICL. Pre- and post-surgical best-corrected visual acuity (BCVA), post-operative complications and graft rejection rates were compared between the two groups. Mean follow-up time was 28 (range, 12 and 76) months. RESULTS: ICLs were implanted during P-CT surgery in 14 (70%) eyes, and as a secondary procedure after P-CT in 6 (30%) eyes. ICLs were implanted in PC in 12 (60%) and in AC in 8 (40%) eyes. Mean preoperative BCVA was 0.064 (range, 0.001-0.02) in PC group and 0.02 (range, 0.001-0.1) in AC group (p=0.86). Mean postoperative BCVA was 0.17 (range, 0.0001-1.0) in PC group and 0.14 (range, 0.0001-0.4) in AC group (p=0.81). Glaucoma developed in 5 (41.6%) eyes with PC ICL. No eye with AC ICL developed glaucoma over time. DISCUSSION AND CONCLUSION: Both AC and PC ICL implantation provide favorable visual outcomes and complication rates in CT patients. However, PC implantation of ICL seems to increase glaucoma incidence.

BACKGROUND AND OBJECTIVE: To report the clinical feature of dislocated retropupillary iris-claw aphakic intraocular lens (IOL) and outcomes of reenclavation. PATIENTS AND METHODS: In this multicenter, retrospective case series, 225 eyes of 225 patients underwent retropupillary fixation of iris-claw aphakic IOL and the cases with haptic dislocation were reviewed. RESULTS: Single haptic dislocation was observed in 22 of 225 eyes (9.8%) after 89 ± 77 days (range: 5 days to 277 days) postoperatively, and resolution was achieved through reenclavation without any intraoperative complications in all patients. Iris atrophy in 13 eyes (59%) and history of face washing at the time of dislocation in five patients (23%) were noted. Reenclavation did not cause statistically significant change in best-corrected visual acuity ( P = .315), spherical equivalent ( P = .660), or endothelial cell count ( P = .182) compared to those after the primary surgery. CONCLUSION: Single-haptic dislocation of retropupillary iris-claw aphakic IOL is not a rare complication and can be safely and effectively corrected by reenclavation. [ Ophthalmic Surg Lasers Imaging Retina. 2020;51:384–390.]

Background: many reasons can lead to an aphakia without sufficient capsular support for a posterior chamber intraocular lens, such as intraoperative complications during phacoemulsification, intracapsular cataract extraction, ocular trauma and lens dislocation caused by various reasons. Aim of the Work: was to compare retropupillary fixation of an iris-claw IOL (artisan aphakia lens) with transscleral suturing fixation of aposterior chamber IOL for aphakic eyes without sufficient capsular support as regards safety, visual recovery and complications of the procedure. Material and Methods: this a prospective interventional case series study included a total of 45 eyes of 42 patients of the age group 13-60 years, selected from those attending the Ophthalmology Department at Al-Azhar University Hospitals according to the inclusion and exclusion criteria. Results: in group A, the duration ranged from 15 to 45 min with a mean of 30.30±6.06min, in group B, the duration ranged from 35 to 85 min with a mean 60.60±12.41min. The P-Value was< 0. 001. The IOP showed at day 1 postoperative was higher in group B 20.06±4 than group A A16.40±3.9 p value was 0.012, however IOP was nearly at the same level at the end of the follow up period 15.23±3.63 in group A and 15.23±3.63 in group B with p value 0.713. Conclusion: the results of our study indicated that IC-IOL and SF-PCIOL implantations are both satisfactory in correcting aphakia without sufficient capsular support to hold an IOL in the posterior capsule.

An 84-year-old monocular woman was referred to our institution for the management of corneal decompensation in her only eye, the right eye. The patient had secondary implantation of an anterior chamber iris-claw intraocular lens (IOL) for IOL dislocation in the setting of pseudoexfoliation syndrome 2 years before presentation. Descemet-stripping automated endothelial keratoplasty (DSAEK) combined with retropupillary repositioning of the iris-claw IOL using a flipping technique was performed for the treatment of corneal edema. No intraoperative or postoperative complications occurred. Six months postoperatively, the corneal graft was attached and clear and the retropupillary iris-claw IOL was well positioned. The uncorrected distance visual acuity and corrected distance visual acuity improved from counting fingers preoperatively to 20/200 and 20/63, respectively, after surgery. Combined DSAEK and retropupillary refixation of a prepupillary iris-claw IOL using the flipping technique was a safe technique in this patient with corneal decompensation.

A 58-year-old woman presented to us with sudden onset diminution of vision for 10 days following trauma while using mobile phone. Patient had a history of posterior iris claw implantation 3 years ago. On examination, the patient was aphakic and intraocular lens (IOL) was seen enclaved on nasal side and disenclaved on temporal side on ultrasound biomicroscopy. Patient underwent surgery for re-enclavation of temporal haptic by lifting the IOL using 23-gauge pars plana trocar. Patient had a postoperative uncorrected visual acuity of 6/9 and best-corrected visual acuity of 6/6 with refraction. Re-enclavation of partially disenclaved posterior iris claw lens is a minimally invasive technique to restore visual acuity in such cases.

Background: Compared to other refractive surgeries, implantation of phakic intraocular lenses (pIOL) have more desirable results and are potentially reversible procedures due to the possibility of explanting these lenses. These methods usually do not require expensive or special surgical equipment and most ophthalmologists are able to perform these procedures., however disabilities resulting from pIOL are more severe compared to corneal refractive surgery. Due to the potential risk of damage to anterior segment structures, especially corneal endothelial cell loss, pIOL implantation is subjected to debate. Aim of the Work: To evaluate the endothelial cell count changes in eyes implanted with the iris-claw phakic lens for treatment of moderate to high myopia as regard changes in cell density. Patients and Methods: This study included Ten eyes of patients with moderate to high myopia implanted with The Iris-Claw Anterior Chamber Phakic Intraocular Lens at Al-Hussein University Hospital, In this prospective randomized study we did Preoperative specular microscopy and serial postoperative specular microscopy (Topcon SP- 1P, Topcon Medical Inc., Japan).) were performed to evaluate endothelial cell count changes over 6 months. Endothelial cell images were collected in the central region of the cornea before surgery and 1 and 6 months after surgery. The main outcome measures were central corneal ECD and the percentage of corneal endothelial cell loss. Secondary outcome measures were UCVA, BCVA, manifest refraction, and complications. Results: Preoperative mean endothelial cell count was 3198.50 ± 444.67 cells/ mm² (range, 2715.00 – 3846.00 cells/ mm²)., it was 3074.50 ± 410.76 cells/ mm² (range, 2609.00 – 3686.00 cells/ mm²) at 1 month after surgery., 3003.00 ± 411.91cells/ mm² (range, 2532.00 – 3610.00cells/ mm²) at 6 months after surgery. The mean endothelial cell loss was 6.07% at the end of the follow up period with 3.79% at one month postoperative, 2.37% from one to six months postoperative. The mean BCVA improved from 0.27 ± 0.09 preoperatively to 0.44 ± 0.12 postoperatively and the mean UCVA, from 0.02 ± 0.01 to 0.33 ± 0.09 postoperatively, the mean SE was -0.93 ±0.57 D Postoperatively. Conclusion: Artisan phakic IOL had excellent results including., their suitability for high myopes, reversibility, high optical quality, predictability, safety, efficacy, potential gain in visual acuity in myopic patients and did not produce significant corneal endothelial cell loss 6months after surgery.

OBJECTIVES: To present the visual acuity (VA) results and complication rates following Artisan intraocular lens (IOL) insertion in vitrectomised eyes. METHODS: Outcome data were collected for all vitrectomised patients who had undergone Artisan IOL insertion between January 2014 and May 2019 at Moorfields Eye Hospital. All those with follow-up greater than 2 months were included in the analysis. RESULTS: Sixty-nine eyes from 61 patients were included. Average follow up was 2 years. Fifty-five (80%) eyes had at least one ocular comorbidity prior to Artisan IOL insertion. At final follow up 46 (67%) eyes had best-corrected VA better than 6/12. Sixty-three eyes (91%) either gained or maintained VA. Mean post-operative spherical equivalent was −0.2D. Two (3%) lenses became de-enclavated requiring further surgery. Two (3%) eyes developed acute post-operative cystoid macular oedema. Two (3%) required additional topical IOP-lowering therapy to their pre-operative glaucoma regimen. One eye had mild corneal oedema, which persisted for 1 year following surgery and subsequently resolved. CONCLUSIONS: Artisan IOL insertion is a safe and effective option for the surgical correction of aphakia in vitrectomised eyes lacking capsular support. Refractive results comparable to posterior chamber IOL placement can be achieved with these lenses.

To evaluate the endothelial cell loss in patients with iris-claw phakic lenses (Artisan®) in a long-term follow-up. We analyzed the medical records of patients who had undergone iris-claw phakic lens implantation and who had at least 5 years of follow-up. We included 67 eyes with myopic errors (follow-up 9.6 ± 3.0 years) and 10 eyes with mixed astigmatism or hyperopic errors (follow-up 8.8 ± 2.5 years). The mean total endothelial density loss at the last follow-up visit was 18.5% ± 17.0% and 10.5% ± 12.3%, respectively. 29.9% of the eyes in the myopic group and 20% in the hyperopic group lost more than 25% of the preoperative endothelial cell density. During the postoperative follow-up period, 60.8% of the eyes in the myopic group and 40% of the eyes in the hyperopic group lost a higher percentage than the expected physiological loss. Two eyes in the myopic group (3.0%) had a final cell density of less than 1200 cells/mm2. None of the variables studied had a statistically significant association with the percentage of annual endothelial loss in the postoperative period. Three phakic lenses were explanted: two by cataract and one by cataract and severe decrease of the endothelial density (862 cells/mm2). There is a significant endothelial cell loss in a low percentage of the eyes with Artisan® lenses in the long term, and it can decrease to critical levels. Periodic endothelial density evaluations are required for these patients. The selection criteria of surgical candidates could be reevaluated.

Purpose To report the management of a patient with traumatic mydriasis, aphakia and corneal decompensation with a triple procedure: simultaneous pupilloplasty and retropupillary iris-claw intraocular lens (IOL) implantation combined with Descemet stripping automated endothelial keratoplasty (DSAEK). Results An 88-year-old woman was referred to our Institute for consultation on her left eye. The patient had undergone surgical removal of the IOL, without re-implantation, in her left eye 10 months prior to presentation due to traumatic IOL dislocation. At the time of examination, corrected distance visual acuity was counting fingers and intraocular pressure was 10 mmHg. Slit-lamp examination revealed iridoplegia, aphakia and corneal edema. The patient underwent simultaneous pupilloplasty and retropupillary iris-claw IOL implantation combined with DSAEK. Six months postoperatively, the corneal graft was attached and clear, the iris was well reconstructed and almost round, and the iris-claw IOL was in place. Conclusions Simultaneous pupilloplasty and retropupillary iris-claw IOL implantation combined with DSAEK was shown to be a safe surgical technique in a patient with traumatic mydriasis, aphakia and corneal decompensation.

Purpose: To compare the visual outcomes and complications between the eyes receiving retropupillary iris claw intraocular lens (IOL) and scleral-fixated IOL (SFIOL) for post-cataract aphakia. Methods: Medical records of consecutive patients who had iris claw IOL and SFIOL surgery from January 2010 to March 2015, with > 1 year of follow up were retrospectively analyzed. The surgical technique was based on individual surgeon preference. The best-corrected distance visual acuity (BCDVA), previous surgery, surgical technique, and complications were analyzed. Results: Retropupillary iris claw IOL was fixated in 48 eyes (46%) and SFIOL was performed in 56 eyes. Iris claw was performed more frequently at the time of primary cataract surgery (56%) compared to SFIOL (14%) (P < 0.001). At 1 month postoperative, BCDVA was significantly better in the SFIOL group [0.7 ± 0.5 logarithm of minimum angle of resolution (logMAR) in iris claw vs. 0.3 ± 0.2 logMAR in SFIOL, P < 0.001] but this difference did not persist at 1 year (0.4 ± 0.4 logMAR in iris claw vs. 0.3 ± 0.2 logMAR in SFIOL, P = 0.56). Eyes with iris claw IOL experienced significantly more postoperative iritis (17%), intraocular pressure spikes (10%), and ovalization of the pupil (16%). Conclusion: Retropupillary iris claw IOL fixation is as safe as SFIOL for visual rehabilitation of post-cataract aphakia. Visual rehabilitation following iris claw IOL might take longer than SFIOL. Ovalization of the pupil is the commonest adverse effect reported with this type of IOL design.

PURPOSE To perform a paired-eye comparison of secondary iris-claw intraocular lens (IOL) implantation for aphakia. METHODS Retrospective, comparative, nonrandomized interventional case series of aphakic eyes, which underwent secondary iris-claw Artisan IOL (Ophtec BV) implantation for aphakia in one eye and no surgery (group 1) or cataract surgery (group 2) in the fellow eye. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent, central endothelial cell count (cECC), and complications were evaluated before surgery, and at yearly intervals up to 5 years. RESULTS Thirty aphakic eyes implanted with the Artisan were included, and the fellow eyes served as controls. In group 1, postoperative logMAR UDVA and CDVA was significantly higher in the Artisan-implanted eyes (P < 0.01). In group 2, no differences were found in postoperative UDVA and postoperative CDVA between the Artisan-implanted eyes and the eyes that underwent cataract surgery throughout the follow-up (P ≥ 0.05). No statistically significant differences were found in postoperative spherical equivalent between the Artisan-implanted eyes and unoperated eyes or eyes that underwent cataract surgery (P ≥ 0.05). In group 1, cECC was significantly lower in the Artisan-implanted eyes [1973 ± 822 vs. 2616 ± 481 cells per square millimeter at 2 years (P < 0.01)] throughout the follow-up (P < 0.01). In group 2, cECC was not significantly lower in the Artisan-implanted eyes (P ≥ 0.05) [1934 ± 689 vs. 2058 ± 818 cells per square millimeter at 2 years (P = 0.67)]. CONCLUSIONS Visual rehabilitation with secondary iris-claw IOL implantation in aphakic eyes without capsular support seems to be an effective and safe procedure. As expected, uncomplicated cataract surgery with posterior chamber IOL implantation showed lower endothelial cell count loss. Close monitoring of the corneal endothelium is mandatory.

Background: The surgical case of a dropped intraocular lens inside the vitreous cavity constitutes a real challenge for the operating surgeon. Herein, we describe a case series where an alternative optical rehabilitation technique for late intraocular lens-bag complex dislocation has been used. Methods: A modern vitrectomy device was used to remove the capsule with the dropped intraocular lens using sutureless 25-gauge pars plana vitrectomy. To ensure a better aesthetic result, with faster patient recovery and a reduced number of operations, the whole procedure was performed during the same operating session; an iris-claw intraocular lens for aphakia was selected for implantation. The implant was passed behind the constricted iris with the concave surface facing it. The lens was grasped with the manufacturer’s holding forceps and fixed onto the posterior surface of the iris using the special enclavation needles. Results: We have operated 12 eyes in two different clinical centres successfully, with minimal intra- and/or postoperative complications. Conclusion: We believe that this is a viable solution for the visual rehabilitation of patients, who would otherwise need more than one operation for a lens exchange.

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 (pp=0.003) with 65.8% eyes having gain in lines (≥ 2 lines) of CDVA with a safety index of 1.54. Group 2 showed a higher complication rate of 36.59% compared to group 1 (20.34%). Significant complications noted were secondary glaucoma (8%), disenclavation of haptic (4%), subluxation of RFIC lens (1%).Conclusion:The visual outcome with RFIC lenses when combined with other intraocular procedures is mainly affected by the complexity of co-existing pathologies .The complications are more related to the combined procedures performed rather than RFIC lens implantation alone. This may still be acceptable when complication profile of other intraocular lenses is evaluated in similar challenging situations.

Dear Editor, Aphakia with inadequate capsular support is occasionally encountered in young children following trauma, complicated cataract surgery, or lens dislocation, and carries a high risk of amblyopia. Options for visual rehabilitation include aphakic contact lens or intraocular lens (IOL) implantation with fixation either in the anterior chamber (AC), iris, or sclera. Due to long-term corneal concerns, AC-fixated lenses are not generally used in small children. Implantation of a scleral-fixated IOL is a complex procedure and delayed suture rupture with lens dislocation is a major concern [1, 2]. The Artisan iris-claw IOL (Ophtec BV, Groningen, The Netherlands) can be placed either in front (prepupillary) or behind (retropupillary) the iris. Prepupillary Artisan IOL has been reported in children, but doubts remain surrounding the risk of endothelial damage from lens-corneal touch over time [3, 4]. Retropupillary Artisan IOL appears safe in adults [5–7], however, it has rarely been used in children [8, 9]. Here, we report outcomes of retropupillary Artisan IOL implantation in the largest and youngest series of children to date. Eight children with mean age 4.9 years ±3.5 (SD) (range 1.1-11.9 years) underwent retropupillary Artisan IOL implantation between 2011 and 2013 by the same surgeon (GDH) using surgical techniques and postoperative management described previously [9] (Table 1). Surgical indication was aphakia with inadequate capsular support following complicated lens extraction for congenital or developmental cataract (n=5) or penetrating eye injury (n=3). Six children received IOL implantation as a secondary procedure after failure to tolerate contact lenses. Biometry was performed by laser interferometry (IOL Master, Carl Zeiss Meditec AG, Jena, Germany) if tolerated, or alternatively under general anaesthesia immediately prior to implantation surgery using a handheld keratometer (KM-500 Autokeratometer, Nidek Co. Ltd, Aichi, Japan) and A-scan ultrasonograph (Compact Touch, Quantel Medical, Cournon d’Auvergne, France). The Aconstant for retropupillary Artisan IOL implantation was 116.8, as recommended by the manufacturer. Child No.3 received primary IOL implantation at the time of penetrating injury repair using biometry values from the fellow eye. Child No.8 underwent retropupillary enclavation of a dislocated prepupillary Artisan IOL that had been implanted abroad several years earlier. The power of the re-enclavated IOL was not adjusted in view of existing dense amblyopia. Rigorous amblyopia treatment (patching, glasses) was offered to all children in the postoperative period. Visual improvement over a mean followed-up of 20.5 months ±14.0 (range 8-46 months) varied by the degree, if any, of pre-existing amblyopia. Four eyes with either penetrating injury (n=3) or developmental cataract (n=1) but no pre-existing amblyopia achieved final BCVA 0.00-0.10 logMAR. Four other eyes with pre-existing dense amblyopia * Kanmin Xue kanmin.xue@ndcn.ox.ac.uk

Purpose: To evaluate the efficacy and safety of aphakic Artisan–Verysise intraocular lens (IOL) primarily implanted for complicated cataract surgery. Methods: A retrospective analysis of 49 eyes that underwent primary aphakic Artisan IOL implantation for complicated cataract surgery. Pre- and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and spherical equivalents (SE) were compared. Results: The mean age of the participants was 68 ± 12.7 years, and the mean follow-up time was 30.7 ± 14.8 months. The mean BCVA improved significantly from 0.58 ± 0.4 at baseline to 0.44 ± 0.41 after the operation (P = 0.008). The spherical equivalent changed insignificantly from -0.13 ± 1.55 preoperatively to -0.6 ± 1.88 (P = 0.724) at the last visit. Postoperative complications were transient pigmented precipitates in five cases and raised intraocular pressure in one case. Conclusion: Aphakic Artisan IOLs are attractive alternatives in complicated cataract surgery without suffi...

Aim: To study the efficiency and safety of iris reconstruction combined with iris-claw intraocular lens (IOL) implantation in the patients with iris-lens injuries. Settings and Design: Retrospective, noncomparable consecutive case series study. Materials and Methods: Eleven patients (11 eyes) following iris-lens injuries underwent iris reconstructions combined with iris-claw IOL implantations. Clinical data, such as cause and time of injury, visual acuity (VA), iris and lens injuries, surgical intervention, follow-up period, corneal endothelial cell count, and optical coherence tomography, were collected. Results: Uncorrected VA (UCVA) in all injured eyes before combined surgery was equal to or

Purpose: To evaluate the outcomes of implantation of an iris-claw intraocular lens (IC-IOL) in retropupillary position in aphakic patients. Methods: We conducted a prospective interventional study, including 36 aphakic eyes with inadequate capsular support. The postoperative examination included best-corrected visual acuity (BCVA), intraocular pressure (IOP) measurement, central corneal thickness (CCT), and anterior segment examination with emphasis on the anterior chamber reaction and shape of pupil. Follow-up was done for 3 months. Results: Thirty-six eyes of 34 patients, including 22 right eyes and 14 left eyes were included. Indications for surgery were complicated cataract surgery in 38.9% (n = 14), aphakia in 27.8% (n = 10), pseudophakic bullous keratopathy in 16.7% (n = 6), dislocated posterior chamber IOL (PCIOL) in 11.1% (n = 4), IC drop in 2.8% (n = 1), and subluxated PCIOL in 2.8% (n = 1). Postoperatively, the visual acuity improved by at least two lines in 32 (88.9%) and worsened in four (11.1%) eyes at the end of three months. Mean postoperative IOP at the end of the third month was 12.42 mmHg (standard deviation [SD] 2.57; range 11.55–13.29 mmHg). The mean postoperative CCT at the end of the third month was 542.42 microns (SD 13.77; range 537.76–547.07 microns). Sixteen eyes (44.4%) had horizontally oval pupil, eleven eyes (30.6%) had round pupil, and nine eyes (25%) had irregular pupil. Twenty-three eyes (63.9%) presented with significant anterior chamber reaction and seven eyes (19.4%) had corneal stromal edema on postoperative day 1. Conclusion: Our study demonstrated that retropupillary IC-IOL implantation in eyes without adequate capsular support is an effective and safe procedure with a good visual outcome and fewer complications.

Purpose: To assess the visual outcome and complications following retropupillary-fixated iris-claw intraocular lens (IOL) implantation. Methods: For this retrospective, non-comparative study, chart review of patients who underwent retropupillary iris-claw IOL implantation for the correction of aphakia from July 2014 to October 2018 and had a minimum postoperative follow-up of 2 months was carried out. Postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), and complications were noted. Results: One hundred and twenty-two eyes of 122 patients (mean follow-up: 7.48 ± 5.2 months, range, 2 months-3.5 years) were enrolled in the study. The mean logMAR CDVA improved from 1.36 ± 0.52 preoperatively to 0.5 ± 0.42 postoperatively, at the last follow-up visit (P < 0.0001). The final CDVA improved in 110 eyes (90.2%), remained unchanged in 8 eyes (6.6%), and worsened in 4 eyes (3.3%). In cases of pre-existing cystoid macular edema (CME) or excessive intraoperative manipulations, 0.05 ml of 4 mg intravitreal triamcinolone acetonide (IVTA) was injected at the end of the surgery. Twenty eyes (16.4%) had transient ocular hypertension (OHT), 6 eyes (4.9%) had persistent OHT, and 2 eyes (1.6%) progressed to glaucoma. Choroidal detachment was noted in 2 eyes (1.6%), CME in 6 eyes (4.9%), 2 eyes (1.6%) had retinal detachment, 20 eyes (16.4%) had significant ovalization of pupil, 8 eyes (6.6%) had one haptic disenclavation, 1 eye (0.8%) had corneal decompensation, and 1 eye (0.8%) had endophthalmitis. Conclusions: Retropupillary iris-claw IOL provides good visual rehabilitation with a few complications. Its ease of insertion and short surgical time makes it a good option to correct aphakia in patients with an inadequate capsular support.

Purpose. To compare the refractive outcome of 2 different methods of intraocular lens implantation in cases of posterior microphthalmos, primary piggyback IOLs versus secondary iris claw lenses. Methods. This study was a retrospective interventional comparative study that included 60 eyes of 30 patients. The included patients had bilateral microphthalmos with high axial hyperopia and had undergone a lens-based surgical procedure for hyperopia correction. The included patients were equally divided into two groups. The first group had undergone refractive lens exchange (RLE) with primary piggyback IOL implantation. The second group undergone RLE with maximum available IOL power implanted followed by a secondary implantation of Artisan iris-fixated IOL (Ophtec B.V., Groningen, the Netherlands). Results. The 2 groups were highly comparable to each other regarding the mean age, axial length (AL), manifest refraction (MR), and K readings. Postoperatively, there was a statistically significant difference between the 2 groups regarding the manifest refraction spherical equivalent (MRSE), mean absolute error (MAE), and uncorrected distance visual acuity (UDVA). There was no significant difference between the 2 groups regarding the CDVA. At 36 months, 20% and 73% of the eyes were within ±0.5 D of intended refraction at 36 months in 1ry piggyback and 2ry Artisan groups, respectively. Fifty-three percent and 93% of the eyes were within ±1.0 D of intended refraction at 36 months in 1ry piggyback and 2ry Artisan groups, respectively (p=0.001). Conclusion. Secondary procedure with implantation of iris-fixated intraocular lens yielded very good results for treatment of axial hyperopia in cases of posterior microphthalmos. The primary piggyback IOL showed less satisfactory results with cases of under correction and the possible complication of interlenticular opacification. Both groups showed good safety parameters.

Introduction: Iris-claw intraocular lens and scleral-fixation of intraocular lens are the main options for the correction of aphakia with inadequate capsular support. It is still unclear which one is the most appropriate for the management of aphakic eyes without sufficient capsular support. Aim: We compared early post-operative visual function and complications after retropupillary Iris-Claw Intraocular Lens (IOL) implantation and transscleral sutured IOL fixation for the treatment of aphakia in eyes without adequate capsular support. Materials and Methods: This prospective study included 36 aphakic eyes without capsular support. Nineteen eyes underwent posterior chamber implantation of the iris-claw lens (iris-claw group) and 17 eyes underwent transscleral suture fixation of an IOL (transscleral fixation group). Best-Corrected Visual Acuity (BCVA), Intraocular Pressure (IOP), operating time, and complications were compared between the groups. Patients were evaluated pre-operatively and at one day, one week, one month, and three months post-operatively. Results: BCVA was better in the iris-claw than in the transscleral fixation group at post-operative day one (p=0.01), but the groups did not differ significantly at one week, one month, or three months post-operatively (p>0.05). The mean operating time in the iris-claw group was significantly shorter than that in the transscleral fixation group (p

Visual rehabilitation in aphakia has been a challenge with a wide variety of surgical options available for ophthalmologist. We report the visual outcome with retropupillary iris claw lens secondary to intra operative complications and secondary implantation in aphakia. An interventional study on 4 eyes of 4 patients was conducted. Preoperative visual acuity, slit lamp examination and fundus examination were carried out. Anterior vitrectomy and retropupillary fixation of iris claw lens were done. The primary outcome measure was best-corrected visual acuity and secondary postoperative complication was recorded at various intervals. All patients had visual acuity of ≥6/18 postoperatively. Sutureless retropupillary iris claw intraocular lens implantation is a good alternative of scleral-fixated intraocular lenses in aphakic patients.

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%) retropupillary, iris-claw IOL fixations. Preoperatively, the groups were similar in all parameters except for a significantly higher proportion of retropupillary fixations in patients who had previously experienced a closed-globe trauma (p=0.03). The groups showed comparable improvements in BCDVA after surgery (final BCDVA: 0.34 ± 0.45 vs. 0.37 ± 0.50 logMAR in the anterior and retropupillary placement groups, respectively). During follow-up, no group difference was observed in refractive error or CMT. Both groups experienced similarly marked ECD loss and showed similar incidence of postoperative complications, with cystoid macular edema being the most common complication. Multivariable linear regression showed that BCDVA at 1 month was the best predictor of the final BCDVA.Conclusions. Anterior chamber and posterior chamber iris-claw IOL fixations proved equally effective and safe for aphakic correction in eyes with inadequate capsular support.

The authors developed a new surgical technique of retropupillary implantation of an iris-claw intraocular lens (RP-ICIOL). RP-ICIOL is an alternative surgical option to the scleral-fixation technique for the treatment of aphakia without capsular support. Several studies have shown that RP-ICIOL is efficient and safe. However, although it is easier to perform than scleral fixation, it presents some critical issues related to the enclavation procedure. The success of the correct enclavation without excessive surgical manipulations, with subsequent pigment dispersion and without pupil distortion, is highly related to the surgical skills of the individual surgeon. The new technique proposed by the authors consists of using a guide needle to facilitate the enclavation, and to make this surgical procedure standard. The new technique was performed in 26 patients affected by aphakia without capsular support with encouraging functional and anatomical results.