title: Implantation of retropupillar iris claw lenses with and without combined penetrating keratoplasty.
abstract: BACKGROUND
  For aphakic patients without lens-supporting apparatus, secondary lens implantation can be considered. Literature on retropupillar iris claw lens implantation as a safe alternative to scleral fixated posterior chamber lenses is scarce.
  
  
  METHODS
  The study included 22 patients. In ten cases, an iris claw lens was implanted retropupillary without penetrating keratoplasty (group 1), in 12 patients the implantation of a retropupillar iris claw lens was combined with penetrating keratoplasty (group 2). Complications observed were retrospectively evaluated. Previous operations and accompanying diseases were compiled. Reasons for aphakia in group 1/group 2 included perioperative complications (60%/75%) and primary ocular trauma (40%/25%). Unless already performed in an earlier operation, anterior or complete vitrectomy was performed in both groups.
  
  
  RESULTS
  Perioperative complications (within 1 week postoperatively) in group 1 included ocular hypotony in 20%, choroidal detachment in 10%, vitreous haemorrhage in 10% and intraocular lens (IOL) decentration in 10% of the cases; in group 2, transient intraocular pressure elevation in 8% of the cases. Postoperative complications (after the first postoperative week) in group 1 were lens tilt in 10%, lens luxation in 10%, cellular deposits (assumed to be macrophages) on lens surface in 10%, cornea guttata in 10% and epiretinal gliosis in 10% of the cases; in group 2, secondary glaucoma in 33%, iris defect in 8% and corneal ulcer in 8% of the cases.
  
  
  CONCLUSIONS
  Retropupillar iris claw lenses are an alternative to scleral fixated secondary lenses, which are worth considering for aphakic patients without lens supporting apparatus. This approach appears to be recommendable even in cases requiring penetrating keratoplasty, and can be performed as a combined procedure. In these patients, the most frequent complication following iris claw lens implantation seems to be secondary glaucoma.
authors.affiliation: Department of Ophthalmology, University Hospital of Schleswig-Holstein, Kiel, Germany. fruefer@ophthalmol.uni-kiel.de
authors.forename: Florian
authors.initials: F
authors.lastname: Rüfer
authors.forename: Mark
authors.initials: M
authors.lastname: Saeger
authors.forename: Bernhard
authors.initials: B
authors.lastname: Nölle
authors.forename: Johann
authors.initials: J
authors.lastname: Roider
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001036:Aphakia, Postcataract / Q000601:surgery*; D003316:Corneal Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007498:Iris / Q000601:surgery*; D015948:Keratoplasty, Penetrating / Q000379:methods*; D019654:Lens Implantation, Intraocular / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D014792:Visual Acuity
references.citation: J Refract Corneal Surg. 1994 Jan-Feb;10(1):14-9
references.pmid: 7517774
references.citation: J Cataract Refract Surg. 2003 Feb;29(2):301-8
references.pmid: 12648641
references.citation: Ophthalmic Surg. 1992 May;23(5):308-15
references.pmid: 1603529
references.citation: J Fr Ophtalmol. 2003 Dec;26(10):1051-8
references.pmid: 14691399
references.citation: Klin Monbl Augenheilkd. 1995 May;206(5):286-91
references.pmid: 7609366
references.citation: Ophthalmologe. 2002 Jul;99(7):580-3
references.pmid: 12148307
references.citation: Ophthalmic Surg. 1990 Sep;21(9):609-14
references.pmid: 2250866
references.citation: Acta Ophthalmol Scand. 2006 Apr;84(2):197-200
references.pmid: 16637836
references.citation: J Fr Ophtalmol. 2000 Jan;23(1):73-80
references.pmid: 10733359
references.citation: Ophthalmology. 2003 Apr;110(4):840-59
references.pmid: 12689913
references.citation: Ophthalmic Surg Lasers. 1999 May;30(5):375-81
references.pmid: 10334025
references.citation: Curr Opin Ophthalmol. 2000 Aug;11(4):233-40
references.pmid: 10977767
references.citation: Am J Ophthalmol. 2003 Nov;136(5):931-3
references.pmid: 14597054
references.citation: Am J Ophthalmol. 2006 Feb;141(2):308-312
references.pmid: 16458685
references.citation: J Cataract Refract Surg. 2005 Jul;31(7):1441-3
references.pmid: 16105621
references.citation: J Cataract Refract Surg. 1993 Jul;19(4):488-93
references.pmid: 8355155
references.citation: Curr Opin Ophthalmol. 2001 Feb;12(1):47-57
references.pmid: 11150081
references.citation: Arch Ophthalmol. 2004 Aug;122(8):1112-6
references.pmid: 15302649
references.citation: Trans Am Ophthalmol Soc. 1989;87:79-91; discussion 91-3
references.pmid: 2562533