Posterior Iris Fixation of the Iris-Claw Intraocular Lens Implantation through a Scleral Tunnel Incision MEHMET BAYKARA, HI˙KMET OZCETI˙N, SAMI˙ YI˙LMAZ, AND ÖZGUR BU ¨ LENTTI˙MUÇI˙N ● PURPOSE: To evaluate the technique, efficacy, and safety of posterior iris fixation of iris-claw intraocular lens (IOLs) implantation through a scleral tunnel inci- sion for aphakia correction. ● DESIGN: Noncomparative, interventional case series. ● METHODS: A secondary posterior iris fixation of the Artisan iris-claw IOL (Ophthec BV, Groningen, The Netherlands) was implanted for aphakia correction in the authors’ clinical practice. Uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), astigma- tism, manifest refraction, lens position, pigment disper- sion, and intraocular pressure (IOP) were evaluated in 32 consecutive eyes of 32 patients. ● RESULTS: BSCVA was 20/40 or better in 28 eyes (87.50%) during the mean follow-up time (nine months). Mean postoperative spherical equivalent was 0.70 diopt- ers (D; standard deviation [SD], 0.47 D) at six months after surgery. Mean prediction error was 0.13 D (SD, 0.28 D), and mean absolute prediction error was 0.26 D (SD, 0.15 D). Preoperative mean astigmatism was 1.08 D (SD, 0.55 D; range, 0.0 to 2.0 D). At six months after surgery, mean astigmatism was 2.1 D (SD, 0.81 D; range, 0.75 to 3.75 D). There was no significant postoperative IOP increase. Lens position, evaluated by Oculus Pentacam (Pentacam 70700: Oculus, Wetzlar, Germany) and ultra- sound biomicroscopy [UBM] (Ophthalmic Technologies Inc, Toronto, Ontario, Canada), was parallel to the iris plane. ● CONCLUSIONS: Posterior iris fixation of the iris-claw IOL implantation through a scleral tunnel incision is a safe procedure and an effective option for aphakic eyes with- out capsule support. (Am J Ophthalmol 2007;144: 586 –591. © 2007 by Elsevier Inc. All rights reserved.) T HE SURGICAL CORRECTION OF APHAKIC EYES WITH- out adequate capsular support usually presents a diffi- cult management problem. Debate persists between selections of an angle-supported anterior chamber intraocular lens (IOLs) or a sutured posterior chamber IOL. 1–3 There is no consensus on the indications, relative safety, or efficacy of these alternatives. Scleral-fixated IOLs have disadvantages, including that the suturing technique is difficult, surgical time is long, and intraocular manipulation is excessive, even with the use of newer techniques. However, the surgical procedure of a recently developed angle-supported anterior chamber IOL is safe and fast, and the IOL is easy to implant in the anterior chamber; vitreous manipulations usually are not required. However, angle-supported anterior chamber IOLs also are associated with complications, some of which are direct consequences of the presence of haptics in the iridocorneal angle. 4 In 1986, the first iris-claw IOL was implanted in a phakic eye by Worst and Fechner. Some studies already have indicated favorable visual outcomes and a low incidence of intraoperative and postoperative complications with the cur- rent model. 5–7 The Artisan Aphakia IOL (Ophthec BV, Groningen, The Netherlands), one of the latest versions of the iris-fixated IOL, is a single-piece polymethyl methacrylate (PMMA) which has the longest record of safety as an IOL material. The PMMA IOL haptics attach to the iris with clips on both sides of the optic. The haptics have fine fissures to capture, through enclavation, a fold of midperipheral iris stroma, where the iris is virtually immobile, less vascularized, and less reactive. 8 This makes the iris-claw IOL independent of anterior segment size. However, a 5.4-mm posterior corneal incision is needed for the Artisan Aphakia implantation procedure because of the PMMA material. The scleral tunnel incision for cataract surgery was designed to reduce astigmatism and to create a more secure wound. 9 The implantation of the iris-claw IOL behind the iris better preserves the anatomy of the anterior segment with respect to the iridocorneal angle. In this study, we evaluated the technique, visual results, and Pentacam (Pentacam 70700: Oculus, Wetzlar, Germany) and ultra- sound biomicroscopy [UBM] (Ophthalmic Technologies Inc, Toronto, Ontario, Canada) evaluations of secondary poste- rior fixation of Artisan Aphakia iris-claw IOL implantation through a scleral tunnel incision for aphakia correction and management of potential complications. METHODS THIS STUDY CONCERNED 32 EYES OF 32 PATIENTS WITH ages ranging from 45 to 80 years (20 men, 12 women) who underwent iris-claw IOL implantation by the same surgeon (M.B.) between October 21, 2005 and August 14, 2006 at Supplemental Videos available at AJO.com. Accepted for publication Jun 4, 2007. From the Department of Ophthalmology, Uludag University School of Medicine, Bursa, Turkey. Inquiries to Mehmet Baykara, Department of Ophthalmology, Uludag University School of Medicine, 16059 Gorukle/Bursa, Turkey; e-mail: mehmetbaykara@yahoo.com; obtimucin@mynet.com © 2007 BY ELSEVIER INC.ALL RIGHTS RESERVED. 586 0002-9394/07/$32.00 doi:10.1016/j.ajo.2007.06.009