Comparison of outcomes between iris suturing of three piece foldable intraocular lenses and retropupillary iris claw lens implantation techniques

Abstract Background To compare the clinical outcomes and complication rates between iris-fixated three-piece intraocular lenses (IF-IOLs) and retropupillary iris-claw intraocular lenses (IC-IOLs) in eyes without capsular support. Methods This retrospective comparative case series was conducted at a single tertiary ophthalmology center. Eyes with aphakia or dislocated IOL and inadequate capsular support underwent either IF-IOL fixation or retropupillary IC-IOL implantation between 2012 and 2013. Outcomes included changes in corrected distance visual acuity (CDVA), IOL stability, and intraoperative, early (≤ 1 month), and late (> 1 month) postoperative complications. Results Sixty-eight eyes (68 patients) were analyzed, of which 44 underwent IF-IOL and 24 underwent retropupillary IC-IOL implantation. CDVA improved significantly in both groups, from 1.36 ± 0.65 logMAR to 0.68 ± 0.61 logMAR in the IF-IOL group and from 1.02 ± 0.76 logMAR to 0.52 ± 0.33 logMAR in the retropupillary IC-IOL group. The between-group difference in logMAR improvement was not statistically significant (0.68 ± 0.77 vs. 0.47 ± 0.70; P = 0.181). Aphakia was more common in the retropupillary IC group (17/24 [70.8%] vs. 13/44 [29.5%], P = 0.002). Early postoperative complication rates were comparable between the groups ( P = 1.000; Holm-adjusted P = 1.000). Follow-up duration was longer in the retropupillary IC-IOL group than in the IF-IOL group (9.0 ± 8.1 vs. 5.0 ± 4.4 months, P = 0.003). Overall late complications were more frequent in the retropupillary IC-IOL group than in the IF-IOL group (6/24 [25.0%] vs. 2/44 [4.5%]; P = 0.019; Holm-adjusted P = 0.039). Although late postoperative complications were more frequently observed in the retropupillary IC-IOL group, this association was attenuated after adjustment for follow-up duration. No endophthalmitis, suprachoroidal hemorrhage, or clinically significant pupil deformation was observed. Adjusted analysis did not identify surgical technique as an independent predictor of logMAR improvement (adjusted β = 0.191; P = 0.205). Conclusions Both techniques provided comparable visual rehabilitation, but late postoperative complications were more frequent after retropupillary IC-IOL implantation. The small number of late events limits the strength of adjusted safety comparisons.