Iris-Fixated IOL: Advantages & Disadvantages
•Iris-fixated IOL’s use the patient’s iris to support secondary lenses in the absence of adequate capsular support or in the case of a PC rent intraop
•They may be positioned anteriorly or posteriorly (retropupillary location)
PREOPERATIVE CONSIDERATIONS
•Consider the iris anatomy
•Note any prior iridectomies
•Significant atrophy
•Anatomical disruption that would preclude adequate support of an iris-fixated IOL
ADVANTAGES:
•Relatively quick and simple technique (iris claw)
•Excellent cosmesis if performed correctly (iris claw)
•Posteriorly positioned iris-fixated lenses may potentially lead to a lower likelihood of corneal decompensation relative to AC-IOLs
•Posteriorly positioned iris-fixated lenses do not disturb the iridocorneal angle
•Vitrectomy may not be required if placed anteriorly
•Minimal risk of future IOL dislocation if placed anteriorly
•If a displaced 3-piece lens is already present in the eye, this same lens can be repositioned (sutured to the iris) rather than introducing a new lens
DISADVANTAGES:
•Not suitable if there is iris trauma or uveitis
•Long term iris atrophy remains a concern
•May have a higher rate of UGH syndrome, iris chaffing, chronic inflammation and CME
•Requires a larger wound (5.5mm optic diameter) since the IOL is PMMA and not foldable. A scleral tunnel is often required and there is a risk of greater astigmatism
•Risk of dislocation
•Can distort pupil shape (oval ‘cats-eye’) if not properly
•May make post-operative posterior segment examination more difficult
•Irregularly shaped pupils can lead to glare and halos
•Difficult to disenclave once clipped
METHODS OF IRIS FIXATION:
•Iris-Claw/ Iris-Enclavation technique
•Sutured iris fixation technique– Single-haptic/ Double-haptic
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