Secondary iris-claw anterior chamber lens implantation in patients with aphakia without capsular support
Reviewed by Jonathan Chan

This retrospective, non-randomised, non-comparative, interventional study including 128 eyes of 124 patients that presented with aphakia with no capsular support. All patients consecutively underwent Artisan iris-claw intraocular lense (IOL) implantation between 1997 and 2010. The inclusion criteria were: aphakic without capsular support; significant ametropia (hyperopia) and poor binocular single corrected visual acuity with glasses or contact lenses; contact lens intolerance; presence of vitreous contacting the corneal endothelium; subluxation of a pre-existing intraocular lens in the posterior chamber of the eye; anterior chamber depth >3.0mm; corneal endothelial cell count greater >1800 cells/mm2, intraocular pressure within normal limits (with or without hypertensive drops); absence of retinal disease; and a minimum follow-up of one year. The authors reported that the mean age of the study patients was 54.55 years (range, 1-98 years). The mean follow-up period was 31.8 months (SD 23.63). The mean preoperative logarithm of the minimum angle of resolution best spectacle corrected visual acuity (BSCVA) and spherical equivalent (SE) were 0.67 ((SD) 0.53) and 9.63 D (SD 5.50), respectively. At the end of one year postoperative period, the mean logarithm of the minimum angle of resolution BSCVA improved to 0.52 (SD 0.46) (p<0.05), and remained stable for up to a period of five years. One year postoperative, the mean spherical equivalent was -0.52 (SD 2.21) (p<0.05). The mean preoperative cECC was 2237.47 cells/mm2, decreased over the years (p+0.05). At five years the endothelial cell count was 1961.40 cells/mm2. A slight but statistically significant decrease in cECC was observed (p<0.05). The main complications were: pupillary block; transient raised intraocular pressure; IOL replacement; penetrating keratoplasty; cystoid macular oedema. The authors concluded that the iris-claw IOL implantation in aphakic eyes is an effective, predictable and safe procedure in the first five years of follow-up. However, recommended long-term follow-up in prospective studies is required to demonstrate its long-term safety.

Secondary iris-claw anterior chamber lens implantation in patients with aphakia without capsular support.
Güell JL, Verdaguer P, Elies D, et al.
BRITISH JOURNAL OF OPHTHALMOLOGY
2014;98:658-63.