Intraocular Lens Implantation Techniques and Outcomes

Intraocular lens (IOL) implantation has become the cornerstone of cataract surgery and the correction of aphakia, with evolving techniques to address cases lacking sufficient capsular support or complicated by zonular weakness. Standard in-the-bag placement remains the first choice when the capsular bag is intact, ensuring optimal effective lens position and refractive predictability. When the posterior capsule or zonules are compromised, surgeons may turn to alternative strategies including sulcus placement, iris-claw fixation and scleral fixation. Advances in sutureless intrascleral techniques, such as the Yamane double-needle flanged haptic method and Carlevale plug-in approach, aim to reduce suture-related complications and improve lens centration. Iris-claw lenses, fixated either anterior to or behind the iris, provide a rapid and reversible option for secondary implantation, though they carry risks of endothelial cell loss and pigment dispersion. Outcomes are assessed by postoperative visual acuity, refractive error, lens tilt and decentration, endothelial cell density and complication rates such as cystoid macular oedema or dislocation. Global experience highlights the importance of tailored technique selection based on ocular anatomy, previous vitrectomy status and patient comorbidities, with novel materials and preoperative biometry refinements further enhancing refractive accuracy and long-term stability.

Research from Nature Portfolio

Recent studies have compared sutureless scleral-fixated IOL implantation with retropupillary iris-claw lenses in eyes without adequate capsular support. Meta-analytic evidence indicates that scleral-fixated lenses yield marginally better corrected distance visual acuity and induce less surgery-related astigmatism, albeit at the cost of longer operative times. Both approaches demonstrate comparable safety profiles, with similar rates of complications such as lens tilt, decentration and macular oedema. These findings support a patient-centred approach, weighing the visual benefits of scleral fixation against the procedural efficiency of iris-claw implantation.

Intraocular Lens Implantation Techniques and Outcomes publication trend

The graph below shows the total number of articles in intraocular lens implantation techniques and outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Aphakia: Absence of the natural lens, often following cataract extraction without primary IOL implantation.

Scleral fixation: Securing an IOL to the scleral wall, either with sutures or via sutureless flanged haptics.

Iris-claw lens: A rigid IOL design grasped by the mid-peripheral iris, placed anteriorly or retropupillary.

Intrascleral fixation: A sutureless technique that lodges haptics within scleral tunnels or pockets to stabilise the IOL.

Zonular dehiscence: Disruption or weakness of the fibrous zonules that suspend the capsular bag, leading to potential lens instability.

References

1. Refractive outcome and lens power calculation after intrascleral intraocular lens fixation: a comparison of three-piece and one-piece intrascleral fixation technique. Eye and Vision (2023).
2. A meta-analysis of sutureless scleral-fixated intraocular lens versus retropupillary iris claw intraocular lens for the management of aphakia. Scientific Reports (2024).
3. Five-year follow-up of secondary iris-claw intraocular lens implantation for the treatment of aphakia: Anterior chamber versus retropupillary implantation. PLOS ONE (2019).
4. Secondary intraocular lens implantation: a large retrospective analysis. Graefe's Archive for Clinical and Experimental Ophthalmology (2018).