Surgeon weighs iris claw, scleral fixation in absence of capsular support
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VIENNA — Iris fixation and scleral fixation, two techniques that are used in the absence of capsular support, have advantages and disadvantages.
These techniques were reviewed in a presentation at the European Society of Cataract and Refractive Surgeons meeting.
“Iris claw is a fast procedure with potentially no conjunctival opening. The lens is fixated to the iris periphery, so you have minimal effect on the normal physiology of the iris and a low incidence of corneal decompensation, secondary glaucoma or cystoid macular edema,” Matteo Forlini, MD, said.
The main disadvantage is the large corneal opening, 5.5 mm, which may lead to some degree of astigmatism. Accurate enclavation is necessary to avoid the risk for pupil distortion.
Forlini gave pearls on how to perform enclavation for both anterior and retropupillary implantation of the lens.
“You can use viscoelastics to minimize trauma or an anterior chamber maintainer, which I prefer to control the IOP and bleeding. For retropupillary enclavation, you need a spatula; with anterior, you need a hook. For anterior enclavation, remember that the A-constant is 115, and concavity is downward. For retropupillary enclavation, concavity is upward, and the A-constant is 116.5,” he said.
Scleral fixation is a more complex and time-consuming technique, but the IOL is placed in a more physiological position. The classic technique with sutures carries the risk for uveitis and ciliary body erosion. Sutureless implantation is now possible with the Carlevale IOL (md tech), in which the haptics are externalized and fixated within the sclera using scleral flaps or limbus-parallel scleral tunnels.
“It is a fast and safe technique, and no sutures mean lower risk of complications associated with suture degradation, scleral erosion and multiple passes through the sclera and uvea,” Forlini said.
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Forlini M. Secondary IOL implantation in the absence of capsular support: Scleral-fixated vs. iris-claw IOLs. Presented at: European Society of Cataract and Refractive Surgeons meeting; Sept. 8-12, 2023; Vienna.
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