Outcomes of Z-suture scleral fixation and retropupillary iris-claw in patients with insufficient capsular support: A comparative study

PurposeManaging intraocular lens (IOL) implantation in patients with insufficient capsular support can be challenging. 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.SettingThis retrospective study was conducted at Unidade Local de Saúde de Matosinhos, Portugal, between June 2012 and December 2023.MethodsSeventy-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.ResultsThe 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 most common complication was the luxation of one of the haptics of the lens, all in the artisan group (5 eyes).Discussion and/or ConclusionNo 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.