Retroiridial Implantation of an Iris-fixated Iol

Iris-fixated IOLs, positioned either anterior or posterior to the iris plane, are an alternative to scleral-fixated posterior chamber IOLs or angle-fixated anterior chamber IOLs, with several advantages. Specifically, although scleral fixation of a posterior chamber IOL preserves the ocular anatomy, the surgical procedure is complex, with potentially severe complications, extended surgical time, and a long learning curve.1 Implantation of anterior chamber IOLs is more straightforward; however, these IOLs can cause endothelial cell loss, bullous keratopathy, and secondary glaucoma.2 Because positioning an IOL anterior to the iris can cause problems with the corneal endothelium and angle structures, posterior positioning of iris-fixated IOLs has been advocated by some authors in both adult and pediatric populations.3,4 With this retroiridal approach, not only is the eye’s original anatomy better preserved, but also positioning the IOL at a greater distance from the cornea minimizes damage to the endothelium. Studies have demonstrated endothelial cell loss of between 10.5% and 10.9% with anterior positioning of iris-fixated lenses.5,6 In the accompanying diagram, Surgical Technique, we describe a method for implantation of an iris-fixated IOL (Artisan Aphakia IOL; Ophtec) in the posterior chamber. This IOL is most often used when suitable capsular support is not available; however, it also may be used when IOL subluxation occurs after cataract surgery or when the capsular bag breaks due to trauma, causing damage to the zonular structures that results in lens subluxation. Thus far, we have performed this technique in three patients who could not undergo capsular bag implantation due to earlier traumatic cataract with capsular rupture and zonular disinsertion.