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Long-term follow-up shows good results of iris claw lens with posterior iris fixation

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ATHENS, Greece — Long-term results of an iris claw lens with posterior iris fixation show that this method leads to good visual outcomes and a lower complication rate compared with anterior iris fixation.

This technique has been used for about 15 years as an option for patients with missing capsule support.

Oliver Findl, MD

“Obviously you have to adapt the A-constant because this lens was not primarily intended for retropupillary implantation,” Oliver Findl, MD, said at the European Society of Cataract and Refractive Surgeons winter meeting.

He recommended choosing a meridian where the enclavation meets an undamaged part of the iris and performing the 6-mm incision required by the lens 90° off this meridian.

“I do a very steep paracentesis in the meridian which allow the enclavation on both sides without changing hands. Put the OVD over the iris and make sure the pupil is mid-dilated because a small pupil would create problems with positioning the lens through the iris but a large pupil would make enclavation difficult,” he said.

Findl also recommended using the Purkinje reflexes for lens centration because the pupil is stretched and distorted during the procedure. Tilting the IOL slightly helps the enclavation maneuvers, he said.

The largest case series on this technique was published by Forlini and colleagues last year. A total of 320 eyes that had post-traumatic aphakia or post-cataract aphakia or PK associated with vitrectomy were implanted. The follow-up time was 5.3 years, ranging between 1 month and 8 years.

“Visual results were good, considering the severity of many of these cases. BCVA was between 20/40 and 20/80, according to the pathology. Disenclavation occurred in three cases, posterior dislocation in one case, retinal detachment in one case, and a few patients had chronic dull pain, maybe related to the previous trauma,” Findl said. – by Michela Cimberle

Reference:

Forlini M, et al. BMC Ophthalmol. 2015;doi:10.1186/s12886-015-0146-4.

Disclosure: Findl reports no relevant financial disclosures.