Iris-fixated IOLs have several fixation options

[caption id="attachment_5244" align="alignnone" width="750"] Professor David Spalton at the combined ESCRS/EURETINA symposium[/caption]   “Our colleagues in The Netherlands have enormous experience with iris-fixated intraocular lenses (IOLs),” said David J Spalton FRCS, FRCP, FRCOphth, UK, when introducing Rudy MMA Nuijts MD, PhD, The Netherlands, prior to Dr Nuijts’ presentation at a combined EURETINA/ESCRS session in Copenhagen yesterday. “Iris-fixated IOLs eliminate the problems with IOL sizing or damage to the anterior chamber (AC) angle that can be associated with AC IOLs. They’re a one-size-fits-all solution in the absence of capsular support,” said Dr Nuijts. Iris-fixated IOLs have several fixation options. They can be attached to the anterior or posterior face of the iris in horizontal, vertical or oblique orientations, depending on the status of the iris tissue. Dr Nuijts prefers retropupillary fixation. “It’s clear that the further the lens is away from the corneal endothelium, the better,” he said, since “annualised corneal endothelial cell loss is 2-3% for anteriorly-fixated IOLs.” Complications specific to iris-fixated IOLs include anterior uveitis, iris depigmentation, pupillar distortion and spontaneous lens dislocation. These, however, compare favorably with complications due to intrascleral fixation of posterior chamber IOLs, which require more complicated surgery to implant and can lead to damage to the ciliary body and retinal detachment. In addition to complicated cataract cases, iris-fixated IOLs can be used in patients operated for congenital cataract and lens subluxation in Marfan’s syndrome. Despite a long history of good results to date, Dr Nuijts pointed out the need for prospective, long-term studies to compare iris-fixated versus sclera-fixated IOLs.