Outcomes of Z-suture scleral fixation and retropupillary iris-claw in patients with insufficient capsular support: A comparative study

Abstract

Purpose

Managing intraocular lens (IOL) implantation in patients with insufficient capsular support can be challenging. This study compares the safety and efficacy of Akreos AO^® z-suture scleral fixation and Artisan Aphakia IOL^® retropupillary iris claw techniques for patients lacking capsular and zonular support.

Setting

This retrospective study was conducted at Unidade Local de Saúde de Matosinhos, Portugal, between June 2012 and December 2023.

Methods

Seventy-eight eyes of 76 patients were included. Preoperative and one-year postoperative data were collected, including best-corrected visual acuity (BCVA), spherical equivalent, intraocular pressure, and complications. Statistical analysis was performed with SPSS Statistics, version 29.0.

Results

The most common indications for surgery were complicated cataract surgery (38.5%), spontaneous IOL luxation (37.2%), trauma (15.4%), and Marfan syndrome (5.1%). Postoperative BCVA at one year was 0.38 ± 0.45 logMAR in the scleral fixation group and 0.50 ± 0.43 logMAR in the artisan group (p = 0.23). The most common complication was the luxation of one of the haptics of the lens, all in the artisan group (5 eyes).

Discussion and/or Conclusion

No significant difference in postoperative BCVA was found between the two techniques. However, the artisan group had a higher complication rate, suggesting that this should be considered when selecting the surgical approach.