Implantation of retropupillar iris claw lenses with and without combined penetrating keratoplasty

  • Florian RüferEmail author
  • Mark Saeger
  • Bernhard Nölle
  • Johann Roider



For aphakic patients without lens-supporting apparatus, secondary lens implantation can be considered. Literature on retropupillar iris claw lens implantation as a safe alternative to scleral fixated posterior chamber lenses is scarce.


The study included 22 patients. In ten cases, an iris claw lens was implanted retropupillary without penetrating keratoplasty (group 1), in 12 patients the implantation of a retropupillar iris claw lens was combined with penetrating keratoplasty (group 2). Complications observed were retrospectively evaluated. Previous operations and accompanying diseases were compiled. Reasons for aphakia in group1/group 2 included perioperative complications (60%/75%) and primary ocular trauma (40%/25%). Unless already performed in an earlier operation, anterior or complete vitrectomy was performed in both groups.


Perioperative complications (within 1 week postoperatively) in group 1 included ocular hypotony in 20%, choroidal detachment in 10%, vitreous haemorrhage in 10% and intraocular lens (IOL) decentration in 10% of the cases; in group 2, transient intraocular pressure elevation in 8% of the cases. Postoperative complications (after the first postoperative week) in group 1 were lens tilt in 10%, lens luxation in 10%, cellular deposits (assumed to be macrophages) on lens surface in 10%, cornea guttata in 10% and epiretinal gliosis in 10% of the cases; in group 2, secondary glaucoma in 33%, iris defect in 8% and corneal ulcer in 8% of the cases.


Retropupillar iris claw lenses are an alternative to scleral fixated secondary lenses, which are worth considering for aphakic patients without lens supporting apparatus. This approach appears to be recommendable even in cases requiring penetrating keratoplasty, and can be performed as a combined procedure. In these patients, the most frequent complication following iris claw lens implantation seems to be secondary glaucoma.


Aphakia Secondary lens implantation Iris claw Retropupillar Penetrating keratoplasty Complications 


  1. 1.
    Adam R, Bohnke M, Korner F (1995) Results of posterior chamber lens implantation with trans-scleral sulcus suture fixation. Klin Monatsbl Augenheilkd 206:286–291PubMedCrossRefGoogle Scholar
  2. 2.
    Bellamy JP, Queguiner F, Salame N, Montard M (2000) Implantation secondaire: techniques et complications. J Fr Ophtalmol 23:73–80PubMedGoogle Scholar
  3. 3.
    Chaudhry NA, Belfort A, Flynn HW Jr, Tabandeh H, Smiddy WE, Murray TG (1999) Combined lensectomy, vitrectomy and scleral fixation of intraocular lens implant after closed-globe injury. Ophthalmic Surg Lasers 30:375–381PubMedGoogle Scholar
  4. 4.
    Dick HB, Augustin AJ (2001) Lens implant selection with absence of capsular support. Curr Opin Ophthalmol 12:47–57 doi: 10.1097/00055735-200102000-00009 PubMedCrossRefGoogle Scholar
  5. 5.
    Dighiero P, Guigou S, Mercie M, Briat B, Ellies P, Gicquel JJ (2006) Penetrating keratoplasty combined with posterior Artisan iris-fixated intraocular lens implantation. Acta Ophthalmol Scand 84:197–200 doi: 10.1111/j.1600-0420.2005.00573.x PubMedCrossRefGoogle Scholar
  6. 6.
    Downing JE (1992) Ten-year follow up comparing anterior and posterior chamber intraocular lens implants. Ophthalmic Surg 23:308–315PubMedGoogle Scholar
  7. 7.
    Evereklioglu C, Er H, Bekir NA, Zorlu F (2003) Comparison of secondary implantation of flexible open-loop anterior chamber and scleral-fixated posterior chamber intraocular lenses. J Cataract Refract Surg 29:301–308 doi: 10.1016/S0886-3350(02)01526-2 PubMedCrossRefGoogle Scholar
  8. 8.
    Hannush SB (2000) Sutured posterior chamber intraocular lenses: indications and procedure. Curr Opin Ophthalmol 11:233–240 doi: 10.1097/00055735-200008000-00004 PubMedCrossRefGoogle Scholar
  9. 9.
    Hara T, Hara T (2004) Ten-year results of anterior chamber fixation of the posterior chamber intraocular lens. Arch Ophthalmol 122:1112–1116 doi: 10.1001/archopht.122.8.1112 PubMedCrossRefGoogle Scholar
  10. 10.
    Heidemann DG, Dunn SP (1990) Visual results and complications of transsclerally sutured intraocular lenses in penetrating keratoplasty. Ophthalmic Surg 21:609–614PubMedGoogle Scholar
  11. 11.
    Le Quoy O, Papaefthymiou Y (2003) Sclerally fixated intraocular lens implant associated with vitrectomy: a study of 50 cases. J Fr Ophtalmol 26:1051–1058PubMedGoogle Scholar
  12. 12.
    Mimura T, Amano S, Sugiura T, Funatsu H, Yamagami S, Oshika T et al (2003) 10-year follow-up study of secondary transscleral ciliary sulcus fixated posterior chamber intraocular lenses. Am J Ophthalmol 136:931–933 doi: 10.1016/S0002-9394(03)00893-6 PubMedCrossRefGoogle Scholar
  13. 13.
    Mohr A, Hengerer F, Eckardt C (2002) Retropupillare Fixation der Irisklauenlinse bei Aphakie - Einjahresergebnisse einer neuen Implantationstechnik. Ophthalmologe 99:580–583 doi: 10.1007/s00347-001-0563-z PubMedCrossRefGoogle Scholar
  14. 14.
    Rijneveld WJ, Beekhuis WH, Hassman EF, Dellaert MM, Geerards AJ (1994) Iris claw lens: anterior and posterior iris surface fixation in the absence of capsular support during penetrating keratoplasty. J Refract Corneal Surg 10:14–19PubMedGoogle Scholar
  15. 15.
    Simmons RB, Stern RA, Teekhasaenee C, Kenyon KR (1989) Elevated intraocular pressure following penetrating keratoplasty. Trans Am Ophthalmol Soc 87:79–91PubMedGoogle Scholar
  16. 16.
    Singhal S, Sridhar MS (2005) Late spontaneous dislocation (disenclavation) of iris-claw intraocular lenses. J Cataract Refract Surg 31:1441–1443 doi: 10.1016/j.jcrs.2004.11.045 PubMedCrossRefGoogle Scholar
  17. 17.
    Solomon K, Gussler JR, Gussler C, Van Meter WS (1993) Incidence and management of complications of transsclerally sutured posterior chamber lenses. J Cataract Refract Surg 19:488–493PubMedGoogle Scholar
  18. 18.
    Vote BJ, Tranos P, Bunce C, Charteris DG, Da Cruz L (2006) Long-term outcome of combined pars plana vitrectomy and scleral fixated sutured posterior chamber intraocular lens implantation. Am J Ophthalmol 141:308–312 doi: 10.1016/j.ajo.2005.09.012 PubMedCrossRefGoogle Scholar
  19. 19.
    Wagoner MD, Cox TA, Ariyasu RG, Jacobs DS, Karp CL (2003) Intraocular lens implantation in the absence of capsular support: a report by the American Academy of Ophthalmology. Ophthalmology 110:840–859 doi: 10.1016/S0161-6420(02)02000-6 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Florian Rüfer
    • 1
    Email author
  • Mark Saeger
    • 1
  • Bernhard Nölle
    • 1
  • Johann Roider
    • 1
  1. 1.Department of OphthalmologyUniversity Hospital of Schleswig-HolsteinKielGermany

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