Surgical outcomes following retropupillary iris claw intraocular lens implantation in aphakic patients

Objectives: This study aims to evaluate the surgical outcomes following retropupillary iris claw intraocular lens (IC-IOL) implantation in aphakic patients by assessing the post-operative outcomes in terms of best corrected visual acuity (BCVA), intraocular pressure (IOP), corneal endothelium status (via specular microscopy) and any complications following retropupillary implantation of IC-IOLs in primary or secondary aphakia. Materials and Methods: This was a prospective interventional study conducted at a tertiary eye care centre of western India from January 2023 to August 2024. Fifty eyes of 47 aphakic patients (post-cataract surgery complications, congenital or traumatic lens subluxation) underwent retro-pupillary IC IOL implantation. Comprehensive pre-operative and post-operative evaluations included: BCVA, IOP, Corneal endothelial cell density (ECD) and complications. Follow-up was conducted at 1 day, 1 week, 1 month, 3 months and 6 months postoperatively. Results: Mean LogMAR BCVA improved from 1.16 ± 0.21 preoperatively to 0.41 ± 0.12 postoperatively ( P < 0.001). There was minimal ECD loss (2%, P = 0.02), with no cases of corneal decompensation and no significant long-term IOP elevation (mean 13.56 ± 2.83 mmHg, P = 0.028 vs. baseline). The complications noted were: pupil distortion (18%), pigment dispersion (10%), retinal detachment (6%) and macular oedema (2%). Conclusion: Retropupillary IC IOL implantation is a safe and effective method for aphakia correction, offering significant visual rehabilitation with minimal impact on corneal endothelium and IOP. It presents fewer complications compared to alternative techniques, making it a viable option for aphakic patients.