Case Study 2: Iris claw lens

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The term ‘Aphakia’ means ‘absence of human crystalline lens due to any cause.’ And the term ‘sublaxated lens’ means displacement of lens from its normal position. These conditions may be congenital, or may occur due to trauma. There are many procedures to correct the aphakia or sublaxated lens in patients who have trauma history or a complicated surgery. The surgical procedure that is utilized is dependent to some factors such as capsular support, condition of the zonules or condition of iris. With the condition of the presence of adequate capsular support, ciliary sulcus implantation of the intraocular lens (IOL) is the best choice. However, in cases of aphakia or sublaxation (more than 180°) secondary to trauma or complicated surgery, capsular/zonular support is usually absent. In these cases, there are several ways to correct the aphakia such as sutured scleral fixation, intrascleral fixation, angle-supported anterior chamber, and anterior chamber IOL or retropupillary iris-claw IOLs. I have been researching on Iris claw lens recently. Throughout my studies and researches, I came across some interesting cases. Here are several cases of aphakia and sublaxated lens, which was managed by Iris claw intraocular lens.

Case 1 :

  • A female patient of 50 yrs
  • Dx-ant.synechiae with aphakia(R/E)
  • Ant vitrectomy with secondary IOL implantation (iris claw lens) R/E on 21.08.2016
  • Pre op VA: CF-2ft ® 6/12 (L)
  • Post op VA: 6/60
  • IOP: 15 mmHg (B/E)
  • Fundus: WNL

Case 2

  • A male patient of 53yrs
  • H/O Phacolytic glaucoma of L/E
  • Iatrogenic aphakia(L/E) was done on 20.07.2016
  • Secondary IOL(Iris claw lens)L/E was implanted on 07.09.2016
  • Pre op VA: 6/18 ®   CF-3ft (L)
  • 1st POD: 6/18 (L)
  • Post op VA after 2 weeks:

R/E-6/9(+1.50x 30)
L/E-6/ 12( -1.50/ -0.50×60)
add: +2.50D

Pre op IOP:

Post operative IOP:

Case 3

  • Another male patient of 41 years had H/O trauma in his L/E
  • BCVA was

6/6 (R/E)
6/9 p (+10.00 D) in L/E

  • Aphakia e vitreous in A/C Dislocated lens in vitreous
  • Pre operative IOP : R/E: 15 mm Hg

L/E: 20 mm Hg

  • PPL+PPV+Iris claw lens(L/E) was implanted on 18.08.2016
  • On 3rd POD BCVA (L/E) was 3/60
  • After 2 weeks BCVA (L/E) was 6/12 P
  • IOP was 16 mm Hg

Case 4

  • A male of 30 years
  • H/O sublaxated cataractous lens and iridodyalysis following trauma to L/E. He had also H/O bil.keratitis (B/E) few years back.
  • Removal of the lens e anterior vitrectomy(L/E) was done on 22.09.2015.
  • On 06.11.2016,his BCVA

R/E-6/9

L/E-6/36(+11.00 D/+1.50 X 170)

  • There was stromal opacity of the cornea (B/E) with aphakia of L/E
  • On fundoscopy ,R/E-NAD

L/E-Shallow cupping , C:D-0.4,
healthy NRR,
chorioretinal scar around fove

  • IOP:

  • Antiglaucoma medication was prescribed to control the IOP before surgery.
  • Secondary IOL was implanted on 13.10.2016(L/E)
  • On 3rd POD,BCVA (L/E) -660 p
  • After 2 weeks BCVA(L/E)-6/60
  • IOP:

There are no current prevention measures for Aphakia. After an extensive exam of the eye, Diagnosis will establish. Treatment will vary for different age groups.