Clinical Insights into Iris-Claw IOLs in Aphakic Patients at a Tertiary Referral Centre

Purpose : To examine the outcomes and complication rates of iris-claw intraocular lens (IOL) implantation in an aphakic cohort, with a comparison of anterior versus retropupillary enclavation, and an analysis of the biometric spread of implanted IOLs. Methods : In this single-centre retrospective case series, we analysed the medical records of 140 eyes from 134 patients who underwent iris-claw IOL implantation between April 2015 and July 2024. Analysis included patient demographics, surgical approach (anterior vs. retropupillary), lens strength, and both intraoperative and postoperative outcomes. Best-corrected visual acuity (BCVA) was evaluated preoperatively, at 3 months, and at 6–12 months postoperatively. Results : The mean preoperative BCVA was 1.13 logMAR, which improved to 0.47 logMAR at final follow-up (p < 0.001), with 94% of eyes achieving stable or improved vision. The difference in complication rates between anterior (27%) and posterior (18%) enclavation was not statistically significant (p = 0.59). Corneal decompensation only occurred in cases of anterior iris enclavation. Cystoid macular oedema (CMO) occurred in 22 eyes, with all uncomplicated cases resolving with steroid treatment. Late disenclavation of the IOL was a rare complication. Half of the patients achieved a final refraction within ±1D of target. The most commonly implanted lens strengths ranged between +17.0D and +20.0D. Conclusion : Iris-claw IOL implantation is a safe, effective option for aphakic patients lacking capsular support, even in a complex comorbid patient cohort. Our findings suggest that retropupillary placement may be a less traumatic alternative to anterior enclavation, though further evidence is needed.