Outcomes of intraocular lens exchange with combined pars plana vitrectomy and retropupillary iris-claw lens fixation

To evaluate the surgical outcomes of intraocular lens (IOL) exchange combining pars plana vitrectomy (PPV) with retropupillary iris‑claw IOL (ICIOL) fixation. This was a retrospective series of 33 eyes of 32 patients undergoing PPV and secondary retropupillary ICIOL implantation. The primary outcomes included the best‑corrected visual acuity (BCVA), refraction (spherical equivalent [SE], refractive astigmatism), surgically induced astigmatism (SIA) and prediction error. Secondary outcomes included pachymetry, intraocular pressure, surgical time, and complications. The mean BCVA improved from the baseline logarithm of the minimum angle of resolution (logMAR) visual acuity of 0.73 ± 0.55 to 0.18 ± 0.24 at 6 months (p < 0.001). The mean final SE was − 0.40 ± 0.97 diopters (D) (p = 0.001), mean refractive astigmatism 1.36 ± 1.30 D (p = 0.955), mean SIA 1.39 ± 0.93 D, and mean prediction error − 0.28 ± 0.99 D. The mean pachymetry was stable (preoperative 562 ± 35.09 μm; postoperative 558 ± 42.15 μm; p = 0.122). The mean IOP was 15.85 ± 4.89 mmHg preoperatively and 14.72 ± 4.10 mmHg postoperatively (p = 0.563). The mean surgical time was 25.3 ± 4.5 min. Postoperative events included hyphema in 9.1%, cystoid macular edema in 6%, ocular hypertension in 6%, and IOL dislocation in 6%. IOL exchange with combined PPV and retropupillary ICIOL fixation achieved favorable visual and refractive outcomes with a short operating time and low complication rates, supporting this approach as an efficient option for eyes without capsular support.