Comparison of decentration, tilt, and dynamic stability between retropupillary iris claw and scleral fixated intraocular lenses with flanged haptics

PURPOSE: To compare decentration, tilt, and dynamic stability ("wobble") between retropupillary fixated iris claw intraocular lenses (IOL) and double needle flanged scleral fixated technique. SETTING: Vienna Institute for Research in Ocular Surgery, Hanusch Hospital, Vienna, Austria. DESIGN: Monocentric comparative observational study. METHODS: Secondary intraocular lens alignment was evaluated using swept source anterior segment optical coherence tomography to quantify decentration and tilt. Dynamic lens behavior was assessed using a Purkinje meter during 9° saccadic eye movements. Additional outcomes included visual acuity, refraction, and complications. RESULTS: Seventy-two eyes of 72 patients were included, comprising 31 eyes with retropupillary iris claw intraocular lenses and 41 eyes with scleral fixated intraocular lenses. Mean decentration was similar between groups, with no statistically significant difference (598 ± 303 µm vs 535 ± 261 µm; p = 0.57). Mean tilt was lower in the iris claw group than in the scleral fixated group, with a statistically significant difference between groups (6.52 ± 3.20° vs 8.93 ± 5.02°; p = 0.03). Across all gaze directions, iris claw lenses demonstrated greater dynamic instability, with larger post saccadic oscillation amplitudes, longer stationary times, and lower damping ratios (all p < 0.001). Visual acuity, refraction, and complication rates were comparable between groups. The intraocular lens iris distance was smaller in the iris claw group. CONCLUSIONS: Decentration was comparable, whereas iris claw lenses showed less tilt but greater dynamic instability than scleral fixated lenses.