Technique of re-enclavation of post-traumatic disenclaved haptic of posterior iris claw lens in a vitrectomised eye

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.

Comparison of visual acuity in primary and secondary iris claw implantation in western Maharashtra

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. 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. 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).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.

Retropupillary Iris Claw Lens Implantation – A Prospective Observational Study at a Tertiary Health Care Centre in Jaipur, Rajasthan

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

Secondary Sutureless Posterior Chamber Lens Implantation with Two Specifically Designed IOLs: Iris Claw Lens versus Sutureless Trans-Scleral Plugs Fixated Lens

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 < 0.01), and IA was 1.72 +/− 0.96 vs. 0.72 +/− 0.52 (p < 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.

Comparison of anterior and posterior chamber implantation of iris claw lens in corneal transplant patients

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.

Re-Enclavation of a Dislocated Retropupillary Fixated Iris Claw Lens: A Case Report

A male patient, 63 years of age, presented with dislocation of a retropupillary fixated iris claw lens due to nasal haptic disenclavation. During re-enclavation the intraocular lens dislocated again. To avoid further dislocation, both superior fingers of the haptics were pushed through the iris tissue to achieve more stable support of the haptic ends. This method of fixation appeared to be well tolerated.