CLOSED-SYSTEM TECHNIQUE FOR IMPLANTATION OF IRIS-SUPPORTED NEGATIVE-POWER INTRAOCULAR-LENS

BACKGROUND: The iris-supported claw lens can reversibly correct a wide range of ametropia and aniseikonia with excellent predictability and stability. However, concerns regarding its potential harm to the corne al endothelium have prevented its widespread use. Our experience with the closed-system surgical technique and the spreader device used in 1 80 cases between 1987 and 1993 has led us to conclude that potential c omplications are more likely due to the technique of implantation rath er than to the properties of the lens itself. METHOD: We conducted a p rospective study of 35 eyes of 20 consecutive patients (mean age, 38 y ears; range, 21 to 55 years) operated on between August 1993 and Augus t 1994. Preoperative spherical equivalent refractions ranged from -6.0 0 to -21.25 diopters (D) (mean, -12.50 D). Follow up was 6 months (86% of eyes) to 1 year (57% of eyes). Spectacle corrected visual acuity a nd endothelial cell. density were measured prior to, and 1, 6, and 12 months following lens implantation. All data were analyzed using the p aired t-test. RESULTS: Mean endothelial cell density dropped insignifi cantly (p>.10): by 1.22% at 1 month (n=34), by 2.25% at 6 months (n=27 ), and by 1.21% at 12 months (n=18). Spectacle-corrected visual acuity increased significantly (p<.001): from a mean of 0.61 preoperatively to 0.77 at 1 month, 0.84 at 6 months, and 0.93 at 12 months postoperat ively. At 12 months, 15 eyes (75%) had a refraction within +/-0.50 D, 19 eyes (95%) within +/-1.00 D, and 20 eyes (100%) within +/-2.00 of e mmetropia. CONCLUSIONS: Our results suggest that the closed-system app roach using the spreader device allows safe implantation of the Worst iris-supported claw lens.