Anterior Chamber Versus Retropupillary Iris-Claw Intraocular Lens Fixation in Aphakic Children With Insufficient...

To compare structural and visual outcomes of anterior versus retropupillary iris-claw intraocular lens (IOL) implantation in aphakic children with inadequate capsular support.

Thirty-two pediatric aphakic eyes with inadequate capsular support were prospectively randomized to anterior or retropupillary fixation. Outcome measures were evaluated at 1, 6, and 12 months. Visual acuity, refraction, central endothelial cell density (CECD), central corneal thickness (CCT), IOL tilt, and centration of both groups were compared.

In the 32 eyes (18 children), mean age at implantation was 6.5 years. Mean best corrected visual acuity improved to 0.23 ± 0.24 and 0.18 ± 0.21 logarithm of the minimum angle of resolution at 12 months in the anterior and retropupillary groups, respectively (P = .32). There was a decrease in CECD that was significant in the anterior fixation group (P = .006), but not in the retropupillary fixation group (P = .154). The lower CECD in the anterior fixation group was statistically significant at 12 months (P = .018). Mean endothelial cell loss at 12 months was 17.4% and 5.6% in the anterior fixation group and the retropupillary fixation group, respectively. Haptic dis-enclavation occurred in 1 eye per group (6%). Pupillary block occurred in 1 eye (6%) and a significant anterior chamber (AC) reaction occurred in 2 eyes (12%) in the anterior fixation group. At 1 year of follow-up, differences in CCT and angle width between both groups were insignificant. IOL tilt and decentration were less than 4 degrees and less than 0.6 mm, respectively, in both groups. AC was significantly shallower (P < .001) in the anterior fixation group.

Anterior fixation of iris-claw IOLs displayed higher endothelial cell loss than retropupillary fixation at 1 year of follow-up, higher incidence of inflammatory reaction, pupillary block, and shallower AC.