Intraocular Lens Implantation In Patients With Insufficient Capsular Support: From Z-Suture Scleral Fixation To Retropupillary Iris-Claw Technique

Managing intraocular lens (IOL) implantation in patients with insufficient capsular support presents a significant challenge. Two different surgical approaches can be chosen: repositioning of the existing IOL by fixating it to the scleral wall or replacing the IOL-capsule complex with a new IOL. This study compares the safety and efficacy of Akreos AO^® z-suture scleral fixation and Artisan Aphakia IOL^® retropupillary iris claw techniques for patients lacking capsular and zonular support.

This retrospective study was conducted at Unidade Local de Saúde de Matosinhos, Portugal, between June 2012 and December 2023.

Seventy-eight eyes of 76 patients were included. Preoperative and one-year postoperative data were collected, including best-corrected visual acuity (BCVA), spherical equivalent, intraocular pressure, and complications. Statistical analysis was performed with SPSS Statistics, version 29.0.

The most common indications for surgery were complicated cataract surgery (38.5%), spontaneous IOL luxation (37.2%), trauma (15.4%), and Marfan syndrome (5.1%). Postoperative BCVA at one year was 0.38 ± 0.45 logMAR in the scleral fixation group and 0.50 ± 0.43 logMAR in the artisan group (p=0.23). The mean postoperative SE was -0.14 ± 0.94 D in the scleral fixation group and 0.22 ± 1.74 D in the artisan group. The most common complication was the luxation of one of the haptics of the lens, all in the artisan group (5 eyes).

No significant difference in postoperative BCVA was found between the two techniques. However, the artisan group had a higher complication rate, suggesting that this should be considered when selecting the surgical approach.