Dr. Saurabh N. Shah

1. Financial Disclosure: I do not have any financial interests or relationships to disclose.

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Ectopia Lentis…
• Ectopia lentis is a displacement or malposition of the eye's
crystalline lens from its normal location.
• The surgical correction of eyes without adequate capsular
support usually presents a difficult management problem.
• Purpose of this study is evaluate the technique, efficacy,
and safety of posterior iris fixation of iris-claw intraocular
lens (IOLs) implantation through a scleral tunnel incision for
optical correction in patients with ectopia lentis.

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Inclusion criteria…
• More than 180 degrees lens subluxation
• BCVA less than 20 /80
• Monocular diplopia
In this interventional case series, 15 patients were included having
subluxated or dislocated lens with poor vision or diplopia. All the
patients underwent lens removal and retro-pupillary iris fixated
intraocular lens (IOL) implantation.

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Treatment Options…
AC IOLs
Angle fixated anterior chamber
intraocular lenses
SF IOLs
Scleral fixated intraocular lenses
Iris claw anterior
Iris fixated intraocular lenses
surgical options for optical correction include
• ACIOLs and SFIOLs are associated with significant complications like high risk of corneal
decompensation also SFIOL implantation is technically more difficult.
• IFIOLs have the advantage of Retropupillary implantation with enough space between
themselves and the endothelium to avoid injury to the endothelium.

6. Surgical Procedure…
 .
 Intracameral Pilocarpine was used to constrict the pupil.
 Two paracentesis (side ports) were made diagonally
opposite, i.e. at 3 o′ clock and 9 o′ clock positions.
 Iris claw IOL was inserted in AC and rotated such that
haptics were in line with the side ports.
6-mm superior
corneo-sceral
tunnel
Continuous
curvilinear
capsulorhexis (CCC)
with forceps.
Hydroprocedure and Phacoaspiration with I & A
cannula.
Capsular bag was removed with forceps

7. Surgical Procedure…
 Holding the optic of the lens with a lens fixation forceps,
IOL was slipped through the pupillary area and one haptic
was pushed under the iris with gentle manipulation.
 Maintaining the horizontal position, the IOL was recentered
over the pupil behind the iris.
 Simultaneously, dialor was passed through the
paracentesis on the same side and
 Enclavation done by applying gentle pressure over it
through the slotted center of the lens haptic.
 End point was noting the dimple at the site of enclavation.
 Similarly, haptic encalvation in the other side was done.
 Peripheral iridectomy was performed.
 Scleral tunnel was closed with a 10-0 nylon suture.

8. Post op Results…
Post – op with dilated PupilIris Enclavation
• None had serious complications
like endophthalmitis, retinal
detachment, clinically significant
cystoid macular edema or
glaucoma during the follow up.
• No case developed significant
uveitis
• No cases required secondary
surgical intervention….
Post - Op Round Pupil

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Complications encountered…
Mild decentration of IOL
of 0.5mm to 1mm was
seen in one case…
One eye had pigment
deposit on the IOL
surface
and posterior synechiae
Oval pupil in two cases

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PT Age Eye Follow up Diagnosis
Pre Op
BCVA
Post Op
BCVA
Complications
1 15 LE 19 Idiopathic 2/60 6/24
2 12 RE 28 Marfans's 1/60 6/24
3 12 LE,RE 18 Marfans's 3/60 6/18 oval pupil
4 15 RE,LE 36 Idiopathic 4/60 6/12
5 13 LE,RE 22 Idiopathic 1/60 6/12 oval pupil
6 5 RE,LE 28 Idiopathic 4/60 6/18
7 5 LE 32 Idiopathic 1/60 6/18 Decentred IOL
8 13 RE 34 Idiopathic 4/60 6/24
9 11 RE,LE 20
Marfans's
6/60 6/18
10 13 RE,LE 26
Marfans's
4/60 6/24
11 8 RE 34
Idiopathic
3/60 6/18
pigment on IOL
12 13 RE 30
Idiopathic
6/60 6/12
13 13 LE 14 Idiopathic 3/60 6/12
14 12 LE 28 Idiopathic 1/60 6/24
15 16 LE 26 Idiopathic 3/60 6/18

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Discussion…
• In our study, 21 eyes gained BCVA between 6/12 to 6/24 …
• One child had dislocated IOL following trauma. The IOL was successfully
reenclaved.
• No significant postoperative complications were observed.
• At the end of 6 months In all cases the IOL was well-centered, the pupil was
regular, and the eye was quiet with no sign of iritis…
• Our results suggest that the retro-pupillary fixated Iris-claw intraocular lens is
a very attractive alternative in cases ladicking capsular support.The retro-
pupillary fixation of an iris claw lens is easy to perform and has the
advantages of a true posterior chamber implantation with a low intra and
postoperative risk profile.

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Conclusion…
• The retro-pupillary fixation of an iris claw lens has the
advantages of a true posterior chamber implantation with a low
intra and postoperative risk profile.
• The implantation process with this technique is easy.
• We believe it is a better option than a scleral-fixated or angle-
fixated IOL or leaving the child aphakic with subsequent
treatment with glasses or contact lenses.

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