Safety and Efficacy of Retropupillary Fixation of Iris Claw Intraocular Lens versus Sutureless Scleral Fixated Intraocular Lens in the Management of Post Cataract Aphakia

Background: It is standard practice to implant a foldable, one-piece posterior chamber [PC] intraocular lens [IOL] into the capsular bag during uncomplicated cataract surgery. However, conditions like subluxated capsules, pseudo-exfoliation syndrome, and post-complicated cataract surgery can lead to aphakia without adequate capsular support. The aim of the work: This study aims to evaluate the effectiveness of two intraocular lens [IOL] techniques for the treatment of aphakia: scleral fixation and iris claw fixation. Patients and Methods: A prospective study of 40 eyes—20 were fixed with an iris claw IOL using the retropupillary technique and 20 were fixed with a PC IOL using the flanged scleral fixation technique. Results: The most common indication for IOL implantation was posterior capsular rent [n=25, 65%]. Demographics and baseline factors were similar between groups. Uncorrected distance visual acuity significantly improved in both groups at 6 months [p>.001] with no difference at final follow-up. In the iris claw group, 25% developed ovalization. Excessive IOP occurred in 1% and 3% of scleral fixation and iris claw cases, respectively. Iris atrophy affected 30% of iris claw cases. Cystoid macular edema complicated 3 scleral fixation cases. Conclusion: For aphakia, iris claw IOL fixation and scleral fixation provide good visual outcomes at 6 months with an acceptable safety profile.