Compare the outcome of different scleral fixation (SFIOL) and retropupillary iris-claw intraocular lens (RPICIOL) in correcting aphakia: a meta-analysis

Abstract Importance: The varied techniques for aphakia correction, each with its different surgical complexity and duration, necessitate a comparative evaluation focused on postoperative complications, such as iris damage and raised intraocular pressure, to guide tailored surgical decisions for personalized patient care. Objective: To compare the postoperative outcomes of retropupillary iris-claw and various scleral fixation intraocular lenses in aphakia correction. Data Sources: Systematic review of studies from PubMed, Scopus, ScienceDirect, Embase, and Google Scholar from 2011-2024, including unpublished grey literature Study Selection: Selection was limited to studies directly comparing RPICIOL with SFIOL techniques reporting specific outcomes such as iris damage, intraocular pressure changes, and visual acuity. Inclusion criteria were applied through a systematic, independent review by dual researchers. Data Extraction and Synthesis: PRISMA guidelines were adhered to, and two independent reviewers abstracted data. A random-effects model was primarily used, with a fixed-effect model applied in cases of low heterogeneity. Effect sizes were calculated via standardized mean differences and odds ratios. Main Outcomes and Measures: Primary outcomes included Best Corrected Visual Acuity and incidences of iris damage, rise in intraocular pressure, retinal detachment, and cystoid macular edema at six months postoperatively Results: Best Corrected Visual Acuity at six months postoperatively favored the iris-claw over the Yamane method with a standardized mean difference (SMD) of 0.0592 (95% CI: [0.0166, 0.1018], p=0.0065). The iris-claw was associated with an increased risk of iris damage when compared to Yamane and prolene 10.0 suture methods OR of 8.65 (95% CI: [2.51, 29.80]), and 2.80 (95% CI: [1.05, 7.46]) respectively, however, it had a lower risk of a rise in IOP at six months postoperatively when compared to prolene 10.0 suture with an odds ratio (OR) of 0.44 (95% CI: [0.24, 0.79]. In addition, no significant difference in cystoid macular edema or retinal detachment at six months postoperatively was observed among the various techniques. Conclusion and Relevance: This study suggests that while the iris claw technique may carry a higher risk of iris damage, it has some advantages in terms of shorter surgical time, lower incidence of raised IOP when compared to the prolene 10.0 suture, with comparable postoperative outcomes, including, BCVA, RD, and CME.