Abstract

DO.03.06

Secondary lens implantation of retropupillary iris-claw-lenses and sclera fixated posterior chamber lenses – clinical comparison of complications

Rüfer F., Saeger M., Nölle B., Roider J.
Augenklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel

Objective: Aphakic patients with loss of capsular support undergo secondary implantation of sclera fixated posterior chamber lenses in many cases. How far implantation of retropupillary iris-claw-lenses is a safe alternative to sclera fixation has not been compared thoroughly enough by now.
Methods: The data of 77 patients who underwent secondary lens implantation were compared retrospectively. In 26 cases retropupillary iris-claw-lenses were implanted (group 1), in 51 cases sclera fixated posterior chamber lenses were implanted (group 2). The postoperative complications were analysed. The reasons which lead to aphakia in group 1/ group 2 were: Complications following cataract surgery (54%/53%), primary ocular trauma (30%/29%), Marfan’s disease with lens luxation (8%/6%) and loss of the intraocular lens following vitreous surgery (8%/12%). In group 1 the operation was combined with penetrating keratoplasty in 12 cases. In group 2 vitrectomy was performed in all patients who had none in their history.
Results: In group 1 perioperatively occurred the following complications within one week: Ocular hypotony 8%, choroidal detachment 4%, vitreous hemorrhage 4%, decentration of IOL 4%, transitory IOP elevation 4%; in group 2: Transitory IOP elevation 27%, ocular hypotony 12%, transitory intraocular inflammation 6%, choroidal detachment 4%, vitreous hemorrhage 4%, iris capture 4%, IOL dislocation 4% and retinal detachment 2%. Complications occurring later than one week postoperatively in group 1 were: Secondary glaucoma 27%, IOL luxation 8%, iris lesion 8%, pupillary deformation 4%, corneal ulcer 4%, epiretinal gliosis 4%; in group 2: Secondary glaucoma 6%, retinal detachment 4%, corneal decompensation 4%, pupillary deformation 4%, bacterial keratitis 2%, epiretinal gliosis 2% and lens tilt 2%.
Conclusions: The most common complication following retropupillary implantation of iris-claw-lenses was secondary glaucoma. Secondary implantation of retropupillary iris-claw-lenses seems to be associated with a low complication rate, it is an alternative to sclera sutured secondary lenses in patients with absence of capsular support.

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