Retrofixation of iris claw is the preferred technique for the treatment of aphakia in the absence of capsular support

Session Details

Session Title: Cataract Surgery Complications

Session Date/Time: Monday 15/09/2014 | 08:00-10:30

Paper Time: 08:36

Venue: Boulevard A

First Author: : S.Potti INDIA

Co Author(s): :    J. Madhury              

Abstract Details

Purpose:

To evaluate the technique, results and complications of Retrofixation of Iris Claw lens for the treatment of Aphakia in the absence of capsular support.

Setting:

The Prospective non comparative study was conducted in a teaching hospital in Andhra Pradesh, India.

Methods:

Aphakia is common in the developing world. There are many patients who had cataract surgery in the pre IOL period, who now have uniocular or binocular aphakia. Aphakia as a surgical complication is common especially when trainees are performing surgery. The methods to rehabilitate aphakia are still evolving and current methods include implantation of Anterior Chamber IOL, scleral fixation of an IOL and iris fixation of an IOL. There is limited literature about the use of retrofixation of iris claw from south India. This is a prospective non comparative study consisting of 50 eyes of fifty patients who were aphakic and without visible posterior capsule remnants on dilation. The inclusion criteria were aphakes with a BCVA greater than6/36, had an endothelial cell count greater than 1500 and had adequate iris tissue for enclavation. Patients who were one eyed, or had poor BCVA(<6/36) or had poor visibility due to corneal edema were excluded. Pre operative work up included Uncorrected visual acuity(UCVA) and best corrected visual acuity (BCVA) , slitlamp examination with an important note to the size and shape of the pupil and position of peripheral iridectomy, Applanation tonometry ,Endothelial cell density (ECD) and Pachymetry. Posterior segment evaluation by 90D and indirect ophthalmoscopy. Macula health was evaluated with Optical coherence Tomography. All the surgeries were performed by a single surgeon under Peribulbar anaesthesia. After entry, Iris claw lens is inserted into the anterior chamber after anterior vitrectomy . The claw lens is stabilised with Shepard’s forceps and each haptic is placed under the iris which is enclaved with a reverse Sinskey hook through the side port (video) Patients were followed up at 1 week, 1 month, 3 months, 6 months and 1 year.

Results:

This study comprised of 50 eyes of 50 patients with monocular surgical aphakia.The age of the patients ranged from 30-75 years with a majority of patients in the age group of 60-70 years (55%). Males and Females were equally distributed. All the cases achieved the preoperative BCVA or better. 2 cases (4%) had CME at 3 months time which resolved with PST TriamcinaloneAcetonide. In group 1, 2 cases (4%), 4 cases (8%), 11 cases (22%), 20 cases (40%), 8 cases (16%) had BCVA of 6/24, 6/18, 6/12, 6/9, 6/6 respectively at the end of 1 year. 39 cases (78%) had BCVA of 6/12- 6/6 Keratometry readings stabilised by a month and no change in the corneal astigmatism was noted at the end of 1 year period. No change in the lenticular astigmatism was noted indicating the stablity of the IOL. 2.7% of endothelial cell loss was noted at end of 1 year. No major intraop complications or post operative complications like retinal detachment or bullous keartopathy occurred.

Conclusions:

Iris claw lens is a cost effective and a simple procedure with less time consumption. The techniques is effective in achieving preoperative BCVA with acceptable complication rate and can be performed by the primary cataract surgeon himself even at a primary care centre with the available equipment and a minimal learning curve; obviating the need for referral or complicated and lengthy surgical procedures like scleral fixation. Continued follow up of these patients will help determine the long term safety of these techniques.

Financial Interest:

NONE