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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Adam R, Bohnke M, Korner F (1995) Results of posterior chamber lens implantation with trans-scleral sulcus suture fixation. Klin Monatsbl Augenheilkd 206:286–291

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Bellamy JP, Queguiner F, Salame N, Montard M (2000) Implantation secondaire: techniques et complications. J Fr Ophtalmol 23:73–80

    PubMed  CAS  Google 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 30:375–381

    PubMed  CAS  Google 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

    PubMed  Article  CAS  Google 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

    PubMed  Article  Google Scholar 

  6. 6.

    Downing JE (1992) Ten-year follow up comparing anterior and posterior chamber intraocular lens implants. Ophthalmic Surg 23:308–315

    PubMed  CAS  Google 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

    PubMed  Article  Google 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

    PubMed  Article  CAS  Google 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

    PubMed  Article  Google Scholar 

  10. 10.

    Heidemann DG, Dunn SP (1990) Visual results and complications of transsclerally sutured intraocular lenses in penetrating keratoplasty. Ophthalmic Surg 21:609–614

    PubMed  CAS  Google 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 26:1051–1058

    PubMed  Google 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

    PubMed  Article  Google 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

    PubMed  Article  CAS  Google 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 10:14–19

    PubMed  CAS  Google Scholar 

  15. 15.

    Simmons RB, Stern RA, Teekhasaenee C, Kenyon KR (1989) Elevated intraocular pressure following penetrating keratoplasty. Trans Am Ophthalmol Soc 87:79–91

    PubMed  CAS  Google 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

    PubMed  Article  Google 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 19:488–493

    PubMed  CAS  Google 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

    PubMed  Article  Google 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

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Florian Rüfer.

Additional information

The authors have no financial interest in any of the products mentioned in the text.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Rüfer, F., Saeger, M., Nölle, B. et al. Implantation of retropupillar iris claw lenses with and without combined penetrating keratoplasty. Graefes Arch Clin Exp Ophthalmol 247, 457 (2009). https://doi.org/10.1007/s00417-008-0940-2

Download citation

Keywords

  • Aphakia
  • Secondary lens implantation
  • Iris claw
  • Retropupillar
  • Penetrating keratoplasty
  • Complications