Outcomes of Iris-Claw Anterior Chamber versus Iris-Fixated Foldable Intraocular Lens in Subluxated Lens Secondary to Marfan Syndrome

Purpose: To compare the outcome of phacoemulsification using 2 different iris-fixation techniques for intraocular lens (IOL) replacement, a foldable posterior chamber IOL (PCIOL; AcrySof MA60AC, Alcon Laboratories Inc, Fort Worth, TX) and an iris-claw anterior chamber IOL (ACIOL; Artisan, Ophtec BV), for treatment of subluxated lenses in patients with Marfan syndrome (MFS). Design: Randomized, controlled trial. Participants: A total of 31 eyes of 16 patients with subluxated lenses associated with MFS and a preoperative corrected visual acuity (CVA) <20/40 based on the Early Treatment Diabetic Retinopathy Study chart. Methods: Patients were enrolled and the eye with worse visual acuity was randomly assigned to 1 of 2 study arms: phacoemulsification and iris-fixated PCIOL or phacoemulsification and iris-claw ACIOL; the second eye of the same patient received the other IOL type. Preoperative and postoperative ophthalmologic examination, optical coherence tomography, and endothelial cell counts were performed. Main Outcome Measures: We recorded CVA results at 3, 6, and 12 months, complications, endothelial cell loss, and central retinal thickness. Results: In the iris-fixated PCIOL group, CVA was significantly improved at 3 (P = 0.011; n = 16), 6 (P = 0.006; n = 16), and 12 months (P = 0.002; n = 16). In the iris-claw ACIOL group, CVA was significantly improved at 3 (P = 0.001; n = 15), 6 (P = 0.001; n = 15), and 12 months (P = 0.009; n = 12). The CVA results did not differ significantly between groups. Dislocation of the IOL occurred in 3 of 16 (18.75%) eyes in the PCIOL group. Retinal detachment occurred in 3 eyes (2 in the PCIOL group and 1 in the ACIOL group) and was successfully repaired. Postoperative foveal tomograms in both groups revealed a decrease in the mean foveal thickness (MFT; <= 172 mu m) in 54.16% of the patients. Conclusions: The iris-sutured PCIOL and iris-claw ACIOL produced comparable improvements in CVA at 3, 6, and 12 months postoperatively. Although IOL dislocation tended to occur more frequently in the iris-fixated PCIOL group, the difference was not significant. At 6 months postoperatively, all study patients tended to have a thinner MFT. None of the patients in either group developed cystoid macular edema. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. Ophthalmology 2010; 117: 1479-1485 (C) 2010 by the American Academy of Ophthalmology.