Long-Term Clinical and Structural Outcomes Following Iris-Claw IOL Exchange for Dislocated Intraocular Lenses

Objectives: Intraocular lens dislocation is a well-recognized complication of cataract surgery, necessitating secondary interventions such as retropupillary iris-claw IOL implantation. While effective, this procedure requires larger incisions that may induce significant astigmatism. This study aimed to (1) evaluate anterior chamber changes following retropupillary ICIOL implantation and (2) compare surgically induced astigmatism between corneal and scleral incision techniques. Methods: In this prospective cohort study, patients with IOL dislocation underwent 25-gauge pars plana vitrectomy with ICIOL implantation. Anterior chamber depth, volume, and angle configuration were measured across 12 meridians preoperatively, at 1-1.5 months (short-term), and 5-6 months (long-term). Surgically induced astigmatism was compared between the corneal and scleral incision groups. Statistical analysis included Shapiro-Wilk, Mann-Whitney U, and repeated-measures ANOVA tests. Results: This prospective study included 40 patients (22 females, 18 males) with a mean age of 76.3 ± 5.38 years (range 65-86). Significant reductions in ACD and ACV occurred postoperatively ( p < 0.05), with partial recovery at long-term follow up. Surgically induced astigmatism was markedly higher with corneal incisions versus scleral approaches ( p < 0.01 short term; p < 0.05 long term). Anterior chamber angle changes varied by meridian but stabilized by 6 months. Conclusions: Retropupillary ICIOL implantation induces predictable anterior segment remodeling, with scleral incisions offering superior refractive stability. Surgical planning should prioritize scleral techniques to minimize surgically induced astigmatism while maintaining anatomical efficacy. Future innovations in IOL design may further reduce incision-related complications.