Complications Following Secondary Lens Implantation - Retropupillary Iris Claw vs. Sclera Sutured Technique in Aphacic Patients With Absence of Capsular Support

Abstract

Purpose:: If contact lenses or glasses are unsuitable for refractive correction of aphacic patients, secondary lens implantation may be considered. There is no sufficient data proving whether implantation of retropupillary iris claw lenses is a safe alternative to sclera sutured lenses.

Methods:: 77 consecutive patients with absence of capsular support due to complicated surgery (49 patients), trauma (23 patients), inflammation or congenital changes (5 patients) were included. 26 received implantation of a retropupillary iris claw lens, 51 of a sclera sutured lens. The median age at surgery was 67 years. The median follow-up period was 6.8 months (min. 1, max 60 months). Data were analysed retrospectively. In group 1 (iris claw) 2.3 ± 1.3 globe-opening operations were performed before secondary lens implantation, 10 patients (38%) suffered from corneal decompensation, 1 patient (4%) suffered from secondary glaucoma. In group 2 (sclera sutured) 1.7 ± 0.9 operations with opening of the globe took place before secondary lens implantation, 9 patients (18%) had preexisting glaucoma, 5 patients (10%) corneal decompensation, 4 patients (8%) a history of uveitis.

Results:: Early onset complications (within one week postoperatively): Group 1 (iris claw): ocular hypotony 8%, choroidal detachment 4%, decentration of IOL 4%, transitory IOP elevation 4%. Group 2 (sclera sutured): Transitory IOP elevation 27%, ocular hypotony 12%, transitory intraocular inflammation 6%, choroidal detachment 4%, vitreous hemorrhage 4%, iris capture 4%, retinal detachment with need for vitrectomy 2%, IOL-dislocation with need for revision 2%, IOL-decentration 2%. Late onset complications (after one week postoperatively) group 1: Secondary glaucoma 31%, iris lesion 8%, IOL luxation 8%, macrophage coating of IOL 8%, retinal detachment 4%, cornea guttata 4%, pupillary deformation 4%, epiretinal gliosis 4%. Group 2: Secondary glaucoma 8%, macrophage coating of IOL, 6%, papillary deformation 4%, epiretinal gliosis 2%, lens tilt 2%.

Conclusions:: Retropupillary iris claw lens implantation is a considerable alternative to sclera sutured secondary lens implantation in patients with absence of capsular support. The rate of secondary glaucoma seems to be increased in these patients.

Keywords: treatment outcomes of cataract surgery • trauma • anterior segment