Long-term outcomes of iris-claw intraocular lens implantation in aphakic eyes: comparison of fixation techniques and incision types

Abstract Background Aphakia without adequate capsular support remains a challenging condition, and iris-claw intraocular lenses (IOLs) are a valuable option among secondary implantation techniques. This study aimed to evaluate the long-term outcomes of iris-claw IOL implantation in aphakic eyes, specifically comparing anterior versus retropupillary fixation and corneal versus sclero-corneal tunnel incisions, in terms of visual acuity improvement and complication rates. Methods This retrospective study included 340 eyes of 303 patients who underwent iris-claw IOL implantation between August 2006 and August 2023, with a mean follow-up of 46 months (range: 6–147). Of these, 209 eyes received anterior iris fixation and 131 underwent retropupillary fixation. A corneal incision was used in 199 cases and a sclero-corneal tunnel in 141. Best-corrected visual acuity (BCVA), refractive outcomes, and postoperative complications were analyzed. Results A significant and sustained improvement in BCVA was observed across the study population. The high hyperopic preoperative refraction due to aphakia was effectively corrected, with no deviation from the targeted refractive outcomes. The most frequent complications included cystoid macular edema (27.4%) and transient ocular hypertension (17.1%). Severe complications were rare, including retinal detachment (0.6%) and endophthalmitis (0.3%). Most complications were successfully managed with medical or surgical treatment. No significant differences were found in visual outcomes between fixation techniques or incision types. However, a slightly higher incidence of cystoid macular edema was observed in the anterior fixation group, although the difference did not reach statistical significance ( p = 0.083). In addition, corneal incisions were associated with significantly higher surgically induced astigmatism than sclero-corneal tunnels. Two cases in the sclero-corneal group (0.6%) required surgical repair for ciliary body detachment. Conclusions Iris-claw IOL implantation in aphakic eyes demonstrated effective long-term visual rehabilitation with significant improvements in BCVA and accurate refractive correction. Anterior and retropupillary fixation, as well as corneal and sclero-corneal incisions, provided comparable visual outcomes within the study cohort. However, sclero-corneal incisions may be preferable when astigmatism control is prioritized, and retropupillary fixation might reduce the risk of macular complications.