Visual Outcomes and Complications of Secondary Retropupillary Iris-Claw Intraocular Lens Implantation in Surgical Aphakia: A Retrospective Observational Study

Abstract

Background: Retropupillary fixation of an iris-claw intraocular lens (IOL) is a sutureless, relatively quick option for visual rehabilitation of aphakic eyes that lack adequate capsular support. We evaluated visual outcomes and early postoperative complications after secondary retropupillary iris-claw IOL implantation in eyes left aphakic after cataract surgery.
Methods: This single-centre retrospective study reviewed the records of eyes that underwent secondary retropupillary iris-claw IOL implantation between June 2025 and March 2026 at a teaching hospital in southern India. Of 32 eligible eyes, two with pre-existing glaucomatous optic neuropathy were excluded, leaving 30 eyes of 30 patients. Best-corrected visual acuity (BCVA) was recorded with a Snellen chart, converted to logarithm of the minimum angle of resolution (logMAR) units, and compared before surgery and at 1 and 6 months. Complications were extracted from routine follow-up records.
Results: Mean BCVA improved from 1.93 ± 0.24 logMAR before surgery to 0.56 ± 0.56 logMAR at 1 month and 0.22 ± 0.29 logMAR at 6 months [insert Friedman test result and adjusted P values]. At 6 months, 27 eyes (90.0%) had BCVA of 6/18 or better. Pupil ovalisation was the most frequent finding (6 eyes, 20.0%), followed by raised intraocular pressure (4 eyes, 13.3%). Severe (grade 4+) anterior-chamber reaction, hyphaema and cystoid macular oedema each occurred in 3 eyes (10.0%), and iris atrophy in 1 eye (3.3%). One eye with hyphaema and raised intraocular pressure required an anterior-chamber washout.
Conclusion: Secondary retropupillary iris-claw IOL implantation was followed by marked improvement in BCVA over 6 months in selected eyes with surgical aphakia and sufficient iris tissue, with complications that were mostly manageable medically. The small retrospective sample, the absence of a comparison group and the short follow-up limit the strength of these conclusions.