Secondary iris-claw anterior chamber lens implantation in patients with aphakia without capsular support

Background/aims: To evaluate the efficacy, predictability, safety and complications of secondary iris-claw intraocular lens (IOL) implantation in aphakic eyes without capsular support. Methods: Retrospective, non-comparative, interventional case series of 128 aphakic eyes, which consecutively underwent secondary iris-claw Artisan IOL (Ophtec BV) implantation, were included. Manifest refraction, uncorrected visual acuity, best-spectacle corrected visual acuity, biomicroscopy, tonometry, funduscopy and central endothelial cell count (cECC) were evaluated before surgery, and at yearly intervals up to 5 years. Minimum follow-up time was 1 year. Results One hundred twenty-eight eyes were treated. Mean age was 54.55 years (range, 1-98 years). Mean follow-up was 41.8 months (SD 23.63). Mean preoperative logarithm of the minimum angle of resolution BSCVA and spherical equivalent (SE) were 0.67 ((SD) 0.53) and 9.63 D (SD 5.50), respectively. One year postoperatively, mean logarithm of the minimum angle of resolution best-spectacle corrected visual acuity improved to 0.52 (SD 0.46) ( p<0.05), and remained stable up to 5 years. One year postoperatively, mean SE was -0.52 (SD 2.21) ( p<0.05). Mean SE progressively decreased during the 1st year, and remained stable thereafter ( p<0.05). Mean preoperative cECC was 2237.47 (SD 793.33) cells/mm2. cECC showed a slight, though statistically significant, decrease over the years ( p=0.05). Main complications were: 2 pupillary block; 3 transient increase in intraocular pressure; 1 IOL replacement; 2 penetrating keratoplasty and 4 cystoid macular oedema. Conclusions: Iris-claw IOL implantation in aphakic eyes is an effective, predictable and safe procedure in the first 5 years of follow-up. However, a longer follow-up is required to demonstrate its long-term safety.