OSLI Retina

July 2020

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384 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ C L I N I C A L S C I E N C E ■ Single-Haptic Dislocation of Retropupillary Iris- Claw Intraocular Lens: Outcomes of Reenclavation Min Seok Kim, MD, MSc; Sang Jun Park, MD, MSc; Kwangsic Joo, MD, PhD; Hyun Goo Kang, MD; Min Kim, MD; Se Joon Woo, MD, PhD BACKGROUND AND OBJECTIVE: To report the clini- cal feature of dislocated retropupillary iris-claw aphakic intraocular lens (IOL) and outcomes of re- enclavation. PATIENTS AND METHODS: In this multicenter, retro- spective case series, 225 eyes of 225 patients un- derwent retropupillary fixation of iris-claw apha- kic IOL and the cases with haptic dislocation were reviewed. RESULTS: Single haptic dislocation was observed in 22 of 225 eyes (9.8%) after 89 ± 77 days (range: 5 days to 277 days) postoperatively, and resolu- tion was achieved through reenclavation without any intraoperative complications in all patients. Iris atrophy in 13 eyes (59%) and history of face washing at the time of dislocation in five patients (23%) were noted. Reenclavation did not cause sta- tistically significant change in best-corrected visual acuity (P = .315), spherical equivalent (P = .660), or endothelial cell count (P = .182) compared to those after the primary surgery. CONCLUSION: Single-haptic dislocation of retropu- pillary iris-claw aphakic IOL is not a rare complica- tion and can be safely and effectively corrected by reenclavation. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:384-390.] INTRODUCTION Advancements in surgical techniques have enabled surgical corrections for aphakia or inadequate capsular support of the lens, which include sutured scleral fixa- tion, 1-3 angle-supported anterior chamber fixation, 4 and iris fixation. 5,6 Among them, iris-claw intraocular lens (IOL), which has two clips on both sides of the optic for iris capture, is widely used for secondary IOL implantation through a process called enclavation. The knuckles of the iris secure the lens optic parallel to the plane of the iris. 7 The first iris-claw IOL was designed for fixating above the iris plane, whereas one of the latest versions for the aphakic eye is via the retropupillary implantation tech- nique. 8,9 Low endothelial cell loss is considered to be one of the major advantages of retropupillary fixation over anterior fixation. 10 Iris-claw IOL is widely used, and several studies have reported associated intraoperative and postop- erative complications. 9,11-15 Reports have indicated that dislocation of the IOL secondary to trauma or sponta- neous release is one of the possible complications of iris-claw IOL, which requires surgical revision by reen- clavation or scleral fixation. 16-18 The dislocation rate of posterior iris-claw IOL was between 0% and 10%; 6,10-12 insufficient tissue grasping and trauma were the pre- disposing factors of IOL dislocation. 16,17 Successful re- enclavation of subluxated iris-claw phakic IOL to the anterior surface of the iris has been reported without significant adverse effect. 17,18 However, the clinical fea- ture and outcomes as well as risk factors of reenclava- tion of retropupillary iris-fixated aphakic IOL have not been evaluated thoroughly in large numbers. From the Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (MSK, SJP, KJ, SJW); the Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (HGK, MK). Originally submitted December 23, 2019. Revision received December 23, 2019. Accepted for publication May 27, 2020. Supported by the National Research Foundation Bio & Medical Technology Development Program (Grant No. 2018M3A9B5021319) funded by the Korean government (MSIT). The funding organization had no role in the design or conduct of this study. The authors report no relevant financial disclosures. Address correspondence to Min Kim, MD, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea; email: minkim76@gmail.com; and Se Joon Woo, MD, PhD, Department of Ophthalmology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea; email: sejoon1@snu.ac.kr. doi: 10.3928/23258160-20200702-03

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