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Session Title: Complex Cases and Surgery
Session Date/Time: Monday 07/10/2013 | 14:30-16:00
Paper Time: 15:18
Venue: Forum (Ground Floor)
First Author: : V.De Rojas SPAIN
Co Author(s): : M. López A. Gestoso M. de la Fuente J. Pombo I. López
To compare visual outcomes and postoperative complications after secondary iris claw implantation (ICIOL) for aphakia correction in eyes that underwent prepupillar versus retropupillar fixation.
Department of Ophthalmology.Complexo Hospitalario Universitario A Coruńa
Retrospective comparative case series. The surgical data base of a tertiary referral center was searched for cases of ICIOL implantation for aphakia correction in the absence of capsular support from 2008 to 2012. Eyes were divided into two groups: prepupillar and retropupillar fixation of the iris claw. The following data were collected form the medical records: age, sex, etiology of aphakia, associated conditions, preoperative and postoperative corrected distance visual acuity (logMAR CDVA), postoperative intraocular pressure (IOP), postoperative endothelial cell density, distance from endothelium to IOL (Scheimpflug anterior segment imaging evaluation), fundus examination, postoperative macular thickness measurement (optical coherence tomography), surgical complications.
74 cases of ICIOL for aphakia correction were identified: 45 eyes with prepupillar fixation (Group 1) and 29 cases with retropupillar fixation (Group 2). Mean postoperative follow-up was 23.76±15.4 and 7.07±5.27 months in group 1 and 2 respectively (p=0.0001). Mean preoperative logMAR CDVA was 1.07±0.85 and 1.14±0.97 in group 1 and 2 respectively (p=0.993), and it increased significantly after surgery (p=0.0001). Mean postoperative logMAR CDVA was 0.44±0.61 and 0.33±0.33 in group 1 and 2 respectively. Mean postoperative IOP was 16.09±3.42 and 15.37±3.37 mmHg in group 1 and 2 respectively. There was no statistical significant difference either in postoperative CDVA (p=0.793) or IOP (p=0.488) between both groups. Distance from the anterior surface of the IOL to endothelium was significantly larger in group 2 (3704.37±548.51 microns) than in group 1 (2703.10±498.16 microns) (p= 0.0001). Endothelial cell density at the final visit was 1714.1±430.01 cl/mm2 and 1769.7±461.17 cl/mm2 in group 1 and 2 respectively, with no significant difference between groups (p=0.488). Surgical complications included (n: number of cases): Group 1: iris incarceration (1), hyphema (4), vitreous haemorrhage (1), wound dehiscence (1), retinal detachtment (1), cystoid macular edema (4), bullous keratopathy (2). Group 2: cystoid macular edema (3), wound dehiscence (1), retinal tear (1).
Retropupillar implantation of iris claw IOL provided similar visual outcomes and a better safety profile than prepupillar implantation. However, the length of follow-up was significantly larger in group 1 than in group 2; thus, the benefits in the long term of the main advantage of retropupillar enclavation, a larger distance from the endothelium to the anterior surface of the IOL, should be evaluated with a larger follow-up. Financial Disclosure: Authors have no financial interest to disclose
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