Can the Location of the Iris Claw Lens Influence the Development and Timing of Pseudophakic Macular Edema?

Rosario Tourino-Peralba,1,2,* David Lamas-Francis,1,* Laura Freijeiro-Gonzalez,3 Laura Martínez-Pérez,1 Teresa Rodríguez-Ares1 1Department of Ophthalmology, University Hospital of Santiago de Compostela, Santiago, Spain; 2Department of Surgery and Medical-Surgical Specialities, Faculty of Medicine, University of Santiago de Compostela, Santiago, Spain; 3Department of Statistics, Faculty of Mathematics, University of Santiago de Compostela, Santiago, Spain*These authors contributed equally to this workCorrespondence: Rosario Tourino-Peralba, Department of Ophthalmology, University Hospital of Santiago de Compostela, Ramón Baltar s/n, 15706, Santiago de Compostela, Spain, Tel +34 981 951 749, Email [email protected]; [email protected]: This study aims to analyze the incidence of pseudophakic macular edema (PME) and the role of contributing risk factors following prepupillary or retropupillary implantation of iris-claw lenses.Methods: This retrospective cohort study included patients who underwent iris-claw intraocular lens implantation over a 16-year period at the University Hospital of Santiago de Compostela, Spain. The presence of risk factors for PME was recorded, and surgical outcomes included visual acuity, macular OCT scans, and description of complications.Results: A total of 148 eyes from 147 patients were included. Seventy-nine eyes (54.4%) underwent prepupillary iris-claw lens implantation and 69 eyes (46.6%) underwent retropupillary implantation. The mean age of the patients was 68.9 ± 17.2 years. The incidence of PME post-surgery was 23.0% (26.6% prepupillary and 18.8% retropupillary), and the mean time between surgery and diagnosis was similar for both locations (4.8 and 4.7 months, respectively). PME recurred in 33% of the patients, reaching a high rate of 72.7% when the lens location was prepupillary. The mean best-corrected visual acuity was 0.66± 0.55 logMAR preoperatively and 0.38± 0.50 logMAR postoperatively. Postoperative complications occurred in 29 patients (19.6%).Conclusion: PME following iris-claw lens implantation tends to be more frequent and recurrent when the location is prepupillary. Planning for iris-claw lens surgery should consider the risk factors for the development of PME.Keywords: macular edema, aphakia, pseudophakia, iris-anchored intraocular lenses