Comparison of outcomes between iris suturing of three piece foldable intraocular lenses and retropupillary iris claw lens implantation techniques

Background To compare the clinical outcomes and complication rates between iris-fixated three-piece intraocular lenses (IF-IOLs) and retropupillary iris-claw intraocular lenses (IC-IOLs) in eyes without capsular support. Methods This retrospective comparative case series was conducted at a single tertiary ophthalmology center. Eyes with aphakia or dislocated IOL and inadequate capsular support underwent either IF-IOL fixation or retropupillary IC-IOL implantation between 2012 and 2013. Outcomes included changes in corrected distance visual acuity (CDVA), IOL stability, and intraoperative, early (≤ 1 month), and late (> 1 month) postoperative complications. Results Sixty-eight eyes (68 patients) were analyzed, of which 44 underwent IF-IOL and 24 underwent retropupillary IC-IOL implantation. CDVA improved significantly in both groups, from 1.36 ± 0.65 logMAR to 0.68 ± 0.61 logMAR in the IF-IOL group and from 1.02 ± 0.76 logMAR to 0.52 ± 0.33 logMAR in the retropupillary IC-IOL group. The between-group difference in logMAR improvement was not statistically significant (0.68 ± 0.77 vs. 0.47 ± 0.70; P = 0.181). Aphakia was more common in the retropupillary IC group (17/24 [70.8%] vs. 13/44 [29.5%], P = 0.002). Early postoperative complication rates were comparable between the groups ( P = 1.000; Holm-adjusted P = 1.000). Follow-up duration was longer in the retropupillary IC-IOL group than in the IF-IOL group (9.0 ± 8.1 vs. 5.0 ± 4.4 months, P = 0.003). Overall late complications were more frequent in the retropupillary IC-IOL group than in the IF-IOL group (6/24 [25.0%] vs. 2/44 [4.5%]; P = 0.019; Holm-adjusted P = 0.039). Although late postoperative complications were more frequently observed in the retropupillary IC-IOL group, this association was attenuated after adjustment for follow-up duration. No endophthalmitis, suprachoroidal hemorrhage, or clinically significant pupil deformation was observed. Adjusted analysis did not identify surgical technique as an independent predictor of logMAR improvement (adjusted β = 0.191; P = 0.205). Conclusions Both techniques provided comparable visual rehabilitation, but late postoperative complications were more frequent after retropupillary IC-IOL implantation. The small number of late events limits the strength of adjusted safety comparisons.